title: Bone mineral density in partially recovered early onset anorexic patients - a follow-up investigation.
abstract: OBJECTIVE
  There still is a lack of prospective studies on bone mineral development in patients with a history of early onset Anorexia nervosa (AN). Therefore we assessed associations between bone mass accrual and clinical outcomes in a former clinical sample. In addition to an expected influence of regular physical activity and hormone replacement therapy, we explored correlations with nutritionally dependent hormones.
  
  
  METHODS
  3-9 years (mean 5.2 +/- 1.7) after hospital discharge, we re-investigated 52 female subjects with a history of early onset AN. By means of a standardized approach, we evaluated the general outcome of AN. Moreover, bone mineral content (BMC) and bone mineral density (BMD) as well as lean and fat mass were measured by dual-energy x-ray absorptiometry (DXA). In a substudy, we measured the serum concentrations of leptin and insulin-like growth factor-I (IGF-I).
  
  
  RESULTS
  The general outcome of anorexia nervosa was good in 50% of the subjects (BMI >/= 17.5 kg/m2, resumption of menses). Clinical improvement was correlated with BMC and BMD accrual (chi2 = 5.62/chi2 = 6.65, p = 0.06 / p = 0.036). The duration of amenorrhea had a negative correlation with BMD (r = -.362; p < 0.01), but not with BMC. Regular physical activity tended to show a positive effect on bone recovery, but the effect of hormone replacement therapy was not significant. Using age-related standards, the post-discharge sample for the substudy presented IGF-I levels below the 5th percentile. IGF-I serum concentrations corresponded to the general outcome of AN. By contrast, leptin serum concentrations showed great variability. They correlated with BMC and current body composition parameters.
  
  
  CONCLUSIONS
  Our results from the main study indicate a certain adaptability of bone mineral accrual which is dependent on a speedy and ongoing recovery. While leptin levels in the substudy tended to respond immediately to current nutritional status, IGF-I serum concentrations corresponded to the individual's age and general outcome of AN.
authors.affiliation: Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Germany. ulrike.schulze@uniklinik-ulm.de.
authors.forename: Ulrike Me
authors.initials: UM
authors.lastname: Schulze
authors.forename: Simone
authors.initials: S
authors.lastname: Schuler
authors.forename: Dieter
authors.initials: D
authors.lastname: Schlamp
authors.forename: Peter
authors.initials: P
authors.lastname: Schneider
authors.forename: Claudia
authors.initials: C
authors.lastname: Mehler-Wex