title: The ability of low-magnitude mechanical signals to normalize bone turnover in adolescents hospitalized for anorexia nervosa.
abstract: We sought to determine whether low-magnitude mechanical stimulation (LMMS) normalizes bone turnover among adolescents hospitalized for anorexia nervosa (AN). Brief, daily LMMS prevents the decline in bone turnover typically seen during bed rest in AN. LMMS may have application for patients with AN in the inpatient setting to protect bone health.
  
  
  
  Malnourished adolescents with AN requiring medical hospitalization are at high risk for rapid reduction in skeletal quality. Even short-term bed rest can suppress normal patterns of bone turnover. We sought to determine whether LMMS normalizes bone turnover among adolescents hospitalized for complications of AN.
  
  
  
  In this randomized, double-blind trial, we prospectively enrolled adolescent females (n = 41) with AN, age 16.3 ± 1.9 years (mean ± SD) and BMI 15.6 ± 1.7 kg/m2. Participants were randomized to stand on a platform delivering LMMS (0.3 g at 32-37 Hz) or placebo platform for 10 min/day for 5 days. Serum markers of bone formation [bone-specific alkaline phosphatase (BSAP)], turnover [osteocalcin (OC)], and bone resorption [serum C-telopeptides (CTx)] were measured. From a random coefficients model, we constructed estimates and confidence intervals for all outcomes.
  
  
  
  BSAP decreased by 2.8% per day in the placebo arm (p = 0.03) but remained stable in the LMMS group (p = 0.51, pdiff= 0.04). CTx did not change with placebo (p = 0.56) but increased in the LMMS arm (+6.2% per day, p = 0.04; pdiff= 0.01). Serum OC did not change in either group (p > 0.70).
  
  
  
  Bed rest during hospitalization for patients with AN is associated with a suppression of bone turnover, which may contribute to diminished bone quality. Brief, daily LMMS prevents a decline in bone turnover during bed rest in AN. Protocols prescribing strict bed rest may not be appropriate for protecting bone health for these patients. LMMS may have application for these patients in the inpatient setting.
authors.affiliation: Division of Adolescent Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA. amy.divasta@childrens.harvard.edu.|Division of Gynecology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA. amy.divasta@childrens.harvard.edu.
authors.forename: A D
authors.initials: AD
authors.lastname: DiVasta
authors.affiliation: Clinical Research Program, Boston Children's Hospital, Boston, MA, USA.
authors.forename: H A
authors.initials: HA
authors.lastname: Feldman
authors.affiliation: Department of Biomedical Engineering, State University of New York Stony Brook, Stony Brook, NY, USA.
authors.forename: C T
authors.initials: CT
authors.lastname: Rubin
authors.affiliation: Division of Adolescent Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Gallagher
authors.affiliation: Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: N
authors.initials: N
authors.lastname: Stokes
authors.affiliation: Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA.|Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: D P
authors.initials: DP
authors.lastname: Kiel
authors.affiliation: Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: B D
authors.initials: BD
authors.lastname: Snyder
authors.affiliation: Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Gordon
mesh_terms: D000293:Adolescent; D000856:Anorexia Nervosa / Q000150:complications* / Q000503:physiopathology; D001510:Bed Rest / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D016723:Bone Remodeling / Q000502:physiology*; D004311:Double-Blind Method; D005260:Female; D006760:Hospitalization; D006801:Humans; D010024:Osteoporosis / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D010812:Physical Stimulation / Q000379:methods; D014732:Vibration / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Anorexia nervosa; Bed rest; Bone formation; Bone resorption; Bone turnover; Mechanical stimulation; Metabolic disorders; Osteoporosis