title: Bone mineral density, osteoporosis, and fractures among people with eating disorders: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To provide meta-analytical evidence of bone mineral density (BMD), fractures, and osteoporosis rates in eating disorders (ED) vs. healthy controls (HCs).
  
  
  METHODS
  Three independent authors searched major electronic databases from inception till August 2015 for cross-sectional studies reporting BMD in people with ED (anorexia nervosa, (AN); bulimia nervosa, (BN); eating disorders not otherwise specified, (EDNOS)) vs. HCs. Standardized mean differences (SMDs) ±95% and confidence intervals (CIs) were calculated for BMD, and odds ratios (ORs) for osteopenia, osteoporosis, and fractures.
  
  
  RESULTS
  Overall, 57 studies were eligible, including 21 607 participants (ED = 6485, HCs = 15 122). Compared to HC, AN subjects had significantly lower BMD values at lumbar spine (SMD = -1.51, 95% CI = -1.75, -1.27, studies = 42), total hip (SMD = -1.56, 95%CI = -1.84, -1.28, studies = 23), intertrochanteric region (SMD = -1.80, 95%CI = -2.46, -1.14, studies = 7), trochanteric region (SMD = -1.05, 95%CI = -1.44, -0.66, studies = 7), and femoral neck (SMD = -0.98, 95%CI = -1.12, -0.77, studies = 20). Reduced BMD was moderated by ED illness duration and amenorrhea (P < 0.05). AN was associated with an increased likelihood of osteoporosis (OR = 12.59, 95%CI = 3.30-47.9, P < 0.001, studies = 4) and fractures (OR = 1.84, 95% CI = 1.17-2.89, I(2) = 56, studies = 6). No difference in BMD was found between BN and EDNOS vs. HC.
  
  
  CONCLUSIONS
  People with AN have reduced BMD, increased odds of osteoporosis and risk of fractures. Proactive monitoring and interventions are required to ameliorate bone loss in AN.
authors.affiliation: Department of Neurosciences, University of Padova, Padova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Solmi
authors.affiliation: Department of Medicine, Geriatrics Section, University of Padova, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Veronese
authors.affiliation: The Zucker Hillside Hospital, Department of Psychiatry, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA.|Feinstein Institute for Medical Research, Manhasset, NY, USA.
authors.forename: C U
authors.initials: CU
authors.lastname: Correll
authors.affiliation: Department of Neurosciences, University of Padova, Padova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Favaro
authors.affiliation: Department of Neurosciences, University of Padova, Padova, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Santonastaso
authors.affiliation: Department of Medicine, DIMED, University of Padova, Padova, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Caregaro
authors.affiliation: Department of Rehabilitation Sciences, Leuven - University of Leuven, Leuven, Belgium.|Z.org Leuven, KU Leuven - University of Leuven, Kortenberg, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Vancampfort
authors.affiliation: Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Luchini
authors.affiliation: Department of Rehabilitation Sciences, Leuven - University of Leuven, Leuven, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: De Hert
authors.affiliation: Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.|Health Service and Population Research Department, Institute of Psychiatry King's College London, London, UK.
authors.forename: B
authors.initials: B
authors.lastname: Stubbs
mesh_terms: D015519:Bone Density / Q000502:physiology*; D015897:Comorbidity; D001068:Feeding and Eating Disorders / Q000453:epidemiology*; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D010024:Osteoporosis / Q000453:epidemiology*
keywords: anorexia nervosa; bone density; bulimia nervosa; eating disorders; fractures