title: Bone histomorphometric analysis in a patient with anorexia nervosa.
abstract: A 34-year-old Japanese woman with anorexia nervosa (AN) of a body mass index (BMI) of 11.0 kg/cm(2) was admitted to our hospital for assessment of renal dysfunction with a serum creatinine of 1.8 mg/dL and hypokalemia (3.0 mEq/L). Renal biopsy showed chronic interstitial fibrosis with hypertrophy of the juxtaglomerular apparatus. Iliac crest biopsy was performed because of a severe decrease in bone mineral density. It showed active resorption at the periosteal and endosteal surfaces of cortical bone by numerous osteoclasts, as well as bone island formation in cancellous bone due to marked decrease of trabecular connections. A dynamic study using double labeling showed that mineralization of cancellous bone adjacent to cortical bone occurred between the first and second labelings, but did not occur between the second labeling and osteoid formation during the 28-day period before biopsy, which implied that the mineralization was related to promotion of food intake after hospitalization, while the lack of mineralization was due to poor food intake outside hospital. Empty lacunae that indicated the death of osteocytes were seen. Because her bone mass and kidney injury improved after weight gain and normokalemia were achieved by a highly nutritious diet, malnutrition with hypokalemia may have a negative influence on bone formation due to impaired mineralization and may activate bone resorption by osteoclasts secondary to the formation of empty lacunae. This is the first report about the histological features of premenopausal osteoporosis in a patient with AN and kidney injury.
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan. rikako64@toranomon.gr.jp
authors.forename: Rikako
authors.initials: R
authors.lastname: Hiramatsu
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Ubara
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Suwabe
authors.forename: Junichi
authors.initials: J
authors.lastname: Hoshino
authors.forename: Keiichi
authors.initials: K
authors.lastname: Sumida
authors.forename: Eiko
authors.initials: E
authors.lastname: Hasegawa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yamanouchi
authors.forename: Noriko
authors.initials: N
authors.lastname: Hayami
authors.forename: Naoki
authors.initials: N
authors.lastname: Sawa
authors.forename: Kenmei
authors.initials: K
authors.lastname: Takaichi
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D001706:Biopsy; D015519:Bone Density; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D011859:Radiography
keywords: Anorexia nervosa; Bone histomorphometric analysis; Empty lacunae; Hypokalemia; Premenopausal osteoporosis