title: Vertebral fracture assessment in adolescents and young women with anorexia nervosa: a case series.
abstract: Rates of vertebral fracture (VF) in young women with anorexia nervosa (AN) are not well understood. We sought to determine the rates of asymptomatic VF in patients suffering from AN, hypothesizing that VF rates would be higher in subjects with low bone mineral density (BMD) Z-scores. We recruited young women with AN (n = 80) for participation in a longitudinal trial. Dual-energy X-ray absorptiometry images of the lateral thoracic and lumbar spines were obtained for VF assessment at 0, 6, 12, and 18 mo. Thirteen subjects (16%) had a low spinal BMD at baseline (BMD Z-score ≤-2 standard deviation). Using the Genant semiquantitative technique, 2 of 80 subjects at baseline (2.5%) had evidence of a single Genant grade 1 deformity. One subject had a Genant grade 2 deformity. Over the 18-mo trial, 10 incident VFs occurred in 9 subjects (12.5%). Using quantitative techniques, only 2 subjects had a more than 15% loss in vertebral height. Neither anthropometric data nor markers of disease severity were associated with fracture. In conclusion, ill young women with AN were at low risk for asymptomatic VF in our cohort. VFs were not predicted by duration of illness, severity of malnutrition, or traditional measures of areal BMD at the lumbar spine.
authors.affiliation: Division of Adolescent Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Division of Gynecology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: amy.divasta@childrens.harvard.edu.
authors.forename: Amy D
authors.initials: AD
authors.lastname: Divasta
authors.affiliation: Clinical Research Program and Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Henry A
authors.initials: HA
authors.lastname: Feldman
authors.affiliation: Division of Adolescent Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Division of Adolescent Medicine, Hasbro Children's Hospital and Brown University, Providence, RI, USA; Division of Endocrinology, Hasbro Children's Hospital and Brown University, Providence, RI, USA.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Gordon
mesh_terms: D015502:Absorptiometry, Photon; D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000856:Anorexia Nervosa / Q000150:complications*; D015519:Bone Density; D015331:Cohort Studies; D003687:Dehydroepiandrosterone / Q000627:therapeutic use; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae / Q000293:injuries*; D012307:Risk Factors; D016103:Spinal Fractures / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000276:Adjuvants, Immunologic; D003687:Dehydroepiandrosterone
keywords: Adolescents; anorexia nervosa; vertebral fracture; vertebral fracture assessment
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