title: Vertebral Volumetric Bone Density and Strength Are Impaired in Women With Low-Weight and Atypical Anorexia Nervosa.
abstract: Areal bone mineral density (BMD) is lower, particularly at the spine, in low-weight women with anorexia nervosa (AN). However, little is known about vertebral integral volumetric BMD (Int.vBMD) or vertebral strength across the AN weight spectrum, including "atypical" AN [body mass index (BMI) ≥18.5 kg/m2].
  
  
  
  To investigate Int.vBMD and vertebral strength, and their determinants, across the AN weight spectrum.
  
  
  
  Cross-sectional observational study.
  
  
  
  Clinical research center.
  
  
  
  153 women (age 18 to 45): 64 with low-weight AN (BMI <18.5 kg/m2; 58% amenorrheic), 44 with atypical AN (18.5≤BMI<23 kg/m2; 30% amenorrheic), 45 eumenorrheic controls (19.2≤BMI<25 kg/m2).
  
  
  
  Int.vBMD and cross-sectional area (CSA) by quantitative computed tomography of L4; estimated vertebral strength (derived from Int.vBMD and CSA).
  
  
  
  Int.vBMD and estimated vertebral strength were lowest in low-weight AN, intermediate in atypical AN, and highest in controls. CSA did not differ between groups; thus, vertebral strength (calculated using Int.vBMD and CSA) was driven by Int.vBMD. In AN, Int.vBMD and vertebral strength were associated positively with current BMI and nadir lifetime BMI (independent of current BMI). Int.vBMD and vertebral strength were lower in AN with current amenorrhea and longer lifetime amenorrhea duration. Among amenorrheic AN, Int.vBMD and vertebral strength were associated positively with testosterone.
  
  
  
  Int.vBMD and estimated vertebral strength (driven by Int.vBMD) are impaired across the AN weight spectrum and are associated with low BMI and endocrine dysfunction, both current and previous. Women with atypical AN experience diminished vertebral strength, partially due to prior low-weight and/or amenorrhea. Lack of current low-weight or amenorrhea in atypical AN does not preclude compromise of vertebral strength.
authors.affiliation: Neuroendocrine Unit.
authors.forename: Katherine N
authors.initials: KN
authors.lastname: Bachmann
authors.affiliation: Neuroendocrine Unit.
authors.forename: Melanie
authors.initials: M
authors.lastname: Schorr
authors.affiliation: Harvard-Massachusetts Institute of Technology Health Sciences and Technology Program, Massachusetts Institute of Technology, Cambridge, Massachusetts, 02139.|Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts, 02215.
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Bruno
authors.affiliation: Department of Radiology.
authors.forename: Miriam A
authors.initials: MA
authors.lastname: Bredella
authors.affiliation: Neuroendocrine Unit.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Lawson
authors.affiliation: Department of Radiology and.
authors.forename: Corey M
authors.initials: CM
authors.lastname: Gill
authors.affiliation: Neuroendocrine Unit.|Pediatric Endocrine Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, 02114.
authors.forename: Vibha
authors.initials: V
authors.lastname: Singhal
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, 02114.
authors.forename: Erinne
authors.initials: E
authors.lastname: Meenaghan
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, 02114.
authors.forename: Anu V
authors.initials: AV
authors.lastname: Gerweck
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, 02114.
authors.forename: Meghan
authors.initials: M
authors.lastname: Slattery
authors.affiliation: Department of Psychiatry, and.
authors.forename: Kamryn T
authors.initials: KT
authors.lastname: Eddy
authors.affiliation: Cambridge Eating Disorders Center, Cambridge, Massachusetts, 02138.
authors.forename: Seda
authors.initials: S
authors.lastname: Ebrahimi
authors.affiliation: Walden Behavioral Care, Waltham, Massachusetts, 02453.
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Koman
authors.affiliation: Walden Behavioral Care, Waltham, Massachusetts, 02453.
authors.forename: James M
authors.initials: JM
authors.lastname: Greenblatt
authors.affiliation: Walden Behavioral Care, Waltham, Massachusetts, 02453.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Keane
authors.affiliation: Klarman Center, McLean Hospital, and Harvard Medical School, Belmont, Massachusetts, 02478; and.
authors.forename: Thomas
authors.initials: T
authors.lastname: Weigel
authors.affiliation: Neuroendocrine Unit.|Pediatric Endocrine Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, 02114.
authors.forename: Madhusmita
authors.initials: M
authors.lastname: Misra
authors.affiliation: Harvard-Massachusetts Institute of Technology Health Sciences and Technology Program, Massachusetts Institute of Technology, Cambridge, Massachusetts, 02139.|Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts, 02215.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Bouxsein
authors.affiliation: Neuroendocrine Unit.
authors.forename: Anne
authors.initials: A
authors.lastname: Klibanski
authors.affiliation: Neuroendocrine Unit.
authors.forename: Karen K
authors.initials: KK
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000000981:diagnostic imaging / Q000503:physiopathology*; D000856:Anorexia Nervosa / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001835:Body Weight; D015519:Bone Density / Q000502:physiology*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D013131:Spine / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013851:Thinness / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult