title: Strong relationship between vitamin D status and bone mineral density in anorexia nervosa.
abstract: BACKGROUND
  Anorexia nervosa (AN) is associated with impaired bone health and low bone mineral density (BMD) as a consequence of an inadequate peak bone mass in adolescence and bone loss in young adulthood. The vitamin D status with its implications for bone health in patients affected by AN has only been examined previously in small studies.
  
  
  OBJECTIVE
  To evaluate the prevalence of vitamin D deficiency and test the hypothesis that patients with AN and vitamin D deficiency might have worse bone metabolism and lower bone density as compared with AN with adequate vitamin D repletion.
  
  
  METHODS
  We analysed the vitamin D status and bone metabolism in a large cohort (n=89) of untreated patients affected by AN, with amenorrhoea.
  
  
  RESULTS
  Vitamin D deficiency is widespread in untreated patients with AN: 16.9% had 25OH vitamin D levels below 12 ng/ml, 36% below 20 ng/ml and 58.4% below 30 ng/ml. PTH values were higher and BMD at both femoral sites were lower in patients with vitamin D<20 ng/ml. Progressively higher values of BMD were observed by 4 ranks of 25 OH vitamin D values (severe deficiency: <12 ng/ml, deficiency: ≥12 ng/ml and <20 ng/ml, insufficiency: ≥20 and <30 ng/ml and normal: ≥30 ng/ml). In patients with severe vitamin D deficiency BMD at the hip were significantly lower than that measured in groups with values over 20 ng/ml (p<0.001 for trend). The level of significance did not change for values adjusted for BMI or body weight.
  
  
  CONCLUSIONS
  We found a strong relationship between vitamin D status and hip BMD values with additional benefits for those with 25OHD levels above 20 ng/ml. Our results support the design of a randomized placebo-controlled clinical trial on the effect of vitamin D on BMD in patients with AN. The second point, whether 25OHD should be above 20 or 30 ng/ml remains a discussion point.
authors.affiliation: Unit of Rheumatology, Department of Medicine, University of Verona, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Gatti
authors.affiliation: Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89-37016 Garda, Verona, Italy.
authors.forename: Marwan
authors.initials: M
authors.lastname: El Ghoch
authors.affiliation: Unit of Rheumatology, Department of Medicine, University of Verona, Italy. Electronic address: ombretta.viapiana@univr.it.
authors.forename: Ombretta
authors.initials: O
authors.lastname: Viapiana
authors.affiliation: Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89-37016 Garda, Verona, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Ruocco
authors.affiliation: Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89-37016 Garda, Verona, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Chignola
authors.affiliation: Unit of Rheumatology, Department of Medicine, University of Verona, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rossini
authors.affiliation: Unit of Rheumatology, Department of Medicine, University of Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giollo
authors.affiliation: Unit of Rheumatology, Department of Medicine, University of Verona, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Idolazzi
authors.affiliation: Unit of Rheumatology, Department of Medicine, University of Verona, Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Adami
authors.affiliation: Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89-37016 Garda, Verona, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Dalle Grave
mesh_terms: D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000097:blood / Q000150:complications; D000856:Anorexia Nervosa / Q000097:blood* / Q000150:complications; D015992:Body Mass Index; D015519:Bone Density; D001842:Bone and Bones / Q000473:pathology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004032:Diet; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications / Q000453:epidemiology
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: 25 OH vitamin D; Anorexia nervosa; Bone mineral density; Vitamin D