title: Hip structural analysis in adolescent boys with anorexia nervosa and controls.
abstract: BACKGROUND
  We have reported lower hip bone mineral density (BMD) in adolescent boys with anorexia nervosa (AN) compared with controls. Although studies have described bone structure in girls with AN, these data are not available for boys. Hip structural analysis (HSA) using dual-energy x-ray absorptiometry is a validated technique to assess hip geometry and strength while avoiding radiation associated with quantitative computed tomography.
  
  
  OBJECTIVE
  We hypothesized that boys with AN would have impaired hip structure/strength (assessed by HSA) compared with controls.
  
  
  METHODS
  We conducted a cross-sectional study at a clinical research center.
  
  
  METHODS
  We used HSA techniques on hip dual-energy x-ray absorptiometry scans in 31 previously enrolled boys, 15 with AN and 16 normal-weight controls, 12 to 19 years old.
  
  
  RESULTS
  AN boys had lower body mass index SD score (P < .0001), testosterone (P = .0005), and estradiol (P = .006) than controls. A larger proportion of AN boys had BMD Z-scores <-1 at the femoral neck (60% vs 12.5%, P = 0008). Using HSA, at the narrow neck and trochanter region, boys with AN had lower cross-sectional area (P = .03, 0.02) and cortical thickness (P = .02, 0.03). Buckling ratio at the trochanter region was higher in AN (P = .008). After controlling for age and height, subperiosteal width at the femoral shaft, cross-sectional moment of inertia (narrow neck and femoral shaft), and section modulus (all sites) were lower in AN. The strongest associations of HSA measures were observed with lean mass, testosterone, and estradiol. On multivariate analysis, lean mass remained associated with most HSA measures.
  
  
  CONCLUSIONS
  Boys with AN have impaired hip geometric parameters, associated with lower lean mass.
authors: Neuroendocrine and Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. mmisra@partners.org
authors: Madhusmita
authors: M
authors: Misra
authors: Debra K
authors: DK
authors: Katzman
authors: Hannah
authors: H
authors: Clarke
authors: Deirdre
authors: D
authors: Snelgrove
authors: Kathryn
authors: K
authors: Brigham
authors: Karen K
authors: KK
authors: Miller
authors: Anne
authors: A
authors: Klibanski
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D041923:Adolescent Development; D000856:Anorexia Nervosa / Q000097:blood / Q000503:physiopathology*; D015992:Body Mass Index; D015519:Bone Density; D001846:Bone Development; D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging / Q000209:etiology*; D002648:Child; D004958:Estradiol / Q000097:blood; D005269:Femur / Q000000981:diagnostic imaging*; D006615:Hip / Q000000981:diagnostic imaging; D006621:Hip Joint / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D013739:Testosterone / Q000097:blood; D013851:Thinness / Q000209:etiology; D055815:Young Adult
chemical_list: C583557:IGF1 protein, human; D013739:Testosterone; D004958:Estradiol; D007334:Insulin-Like Growth Factor I
references: Osteoporos Int. 2009 Oct;20(10):1767-74
references: 19238304
references: J Clin Endocrinol Metab. 2010 Apr;95(4):1690-8
references: 20194709
references: Int J Eat Disord. 2002 Nov;32(3):301-8
references: 12210644
references: J Clin Endocrinol Metab. 2013 Apr;98(4):1742-9
references: 23476076
references: Pediatr Res. 2002 Apr;51(4):497-504
references: 11919336
references: J Clin Endocrinol Metab. 2008 Aug;93(8):3029-36
references: 18544623
references: J Clin Endocrinol Metab. 2010 Mar;95(3):1265-73
references: 20103654
references: J Bone Miner Res. 2008 Mar;23(3):392-9
references: 17997712
references: Pediatrics. 1990 Sep;86(3):440-7
references: 2388792
references: Osteoporos Int. 2006;17(4):593-9
references: 16447009
references: Endocr Rev. 2002 Jun;23(3):279-302
references: 12050121
references: Osteoporos Int. 2010 Jun;21(6):919-29
references: 19756830
references: Calcif Tissue Int. 2012 Mar;90(3):174-85
references: 22271247
references: Nat Rev Rheumatol. 2010 Jan;6(1):50-9
references: 20046206
references: J Clin Endocrinol Metab. 2009 Nov;94(11):4351-60
references: 19837923
references: Mayo Clin Proc. 1999 Oct;74(10):972-7
references: 10918862
references: J Bone Miner Res. 2008 Dec;23(12):1892-904
references: 18684092
references: Osteoporos Int. 2012 Feb;23(2):543-51
references: 21394495
references: J Am Acad Child Adolesc Psychiatry. 2002 May;41(5):613-8
references: 12014794
references: Bone. 1996 Aug;19(2):181-8
references: 8853863
references: J Bone Miner Res. 2011 Nov;26(11):2753-61
references: 21773991
references: Radiology. 2010 Oct;257(1):167-74
references: 20713613
references: Pediatrics. 2004 Dec;114(6):1574-83
references: 15574617
references: J Bone Miner Metab. 2012 Jul;30(4):454-60
references: 22160359
references: J Clin Endocrinol Metab. 2002 Sep;87(9):4177-85
references: 12213868
references: J Clin Endocrinol Metab. 2011 Jul;96(7):2041-8
references: 21508142
references: Radiology. 2008 Dec;249(3):938-46
references: 19011190