title: Clinical and hormonal variables related to bone mass loss in anorexia nervosa patients.
abstract: A better understanding of the prognostic factors of low bone mass in anorexia nervosa (AN) and development of effective therapeutic strategies is critical. In order to determine which clinical, biochemical, and/or hormonal parameters could be related to bone mineral density (BMD), 47 female AN patients were classified according to the WHO osteoporosis criteria at lumbar spine (LS). This was a cross-sectional study of 16 AN women with osteoporosis criteria and 31without. Control group was 25 healthy, normal-weight, age-matched women. We assessed BMD using dual-energy X-ray absorptiometry at the LS and body composition. We measured serum fasting cortisol, estradiol, insulin-like growth factor-1 (IGF-1), leptin, sex hormone-binding globulin, albumin and retinol binding protein levels. The prevalence of osteoporosis was 34% and osteopenia 19% at the LS. The AN group with osteoporosis had lower IGF-1 and estradiol levels (both p<0.001), lower serum leptin (p<0.02), and higher cortisolemia (p<0.03) levels compared with AN group without osteoporosis. The BMD and T-score at LS was inversely related to the duration of amenorrhea (p<0.02) and directly related to body mass index (BMI, p<0.002), total fat mass (p<0.03), serum IGF-1 (p<0.01), and estradiol levels (p<0.001) in AN patients. We conclude that AN women with a significant BMD loss have a high risk of developing osteoporosis. A low BMD is a consequence of hormonal alterations which include hypoestrogenism, hypoleptinemia, hypercortisolism, and decreases in IGF-1 levels, as well as a low BMI and fat mass.
authors.affiliation: Eating Disorders Unit, Department of Endocrinology and Clinical Nutrition, University Hospital San Cecilio, Granada, Spain. mlfernan@ugr.es
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Fernández-Soto
authors.forename: Amalia
authors.initials: A
authors.lastname: González-Jiménez
authors.forename: Marta
authors.initials: M
authors.lastname: Chamorro-Fernández
authors.forename: Socorro
authors.initials: S
authors.lastname: Leyva-Martínez
mesh_terms: D000293:Adolescent; D000856:Anorexia Nervosa / Q000378:metabolism*; D015519:Bone Density / Q000502:physiology*; D005260:Female; D006801:Humans; D010024:Osteoporosis / Q000378:metabolism*; D055815:Young Adult