Impact of low-weight severity and menstrual status on bone in adolescent girls with anorexia nervosa.
Clinicians currently use different low-weight cut-offs both to diagnose anorexia nervosa (AN) and to determine AN severity in adolescent girls. The purpose of this study was to evaluate the clinical utility of existing cut-offs and severity criteria by determining which are most strongly associated with risk for low bone mineral density (BMD). Height adjusted BMD Z scores were calculated for 352 females: 262 with AN and 90 healthy controls (controls) (12-20.5 years), using data from the BMD in Childhood Study, for the lumbar spine, whole body less head, and total hip. For most cut-offs used to define low weight (5th or 10th BMI percentile, BMI of 17.5 or 18.5, and 85 or 90% of median BMI), AN had lower BMD Z scores than controls. AN at >85 or >90% expected body weight for height (EBW-Ht) did not differ in BMD Z scores from controls, but differed significantly from AN at ≤85 or ≤90% EBW-Ht. Among AN, any amenorrhea was associated with lower BMD. AN had lower BMD than controls across DSM-5 and The Society for Adolescent Health and Medicine (SAHM) severity categories. The SAHM moderate severity classification was differentiated from the mildly malnourished classification by lower BMD at hip and spine sites. Amenorrhea and %EBW-Ht ≤ 85 or ≤ 90% are markers of severity of bone loss within AN. Among severity categories, BMI Z scores (SAHM) may have the greatest utility in assessing the degree of malnutrition in adolescent girls that corresponds to lower BMD.
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.|Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Nurgun
0000-0001-9745-4989
N
Kandemir
Department of Psychiatry, Eating Disorders Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Kendra
K
Becker
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Meghan
M
Slattery
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Shreya
S
Tulsiani
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.|Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Vibha
V
Singhal
Department of Psychiatry, Eating Disorders Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Jennifer J
0000-0003-2601-581X
JJ
Thomas
Department of Psychiatry, Eating Disorders Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Kathryn
K
Coniglio
MGH Biostatistics Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Hang
H
Lee
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Karen K
KK
Miller
Department of Psychiatry, Eating Disorders Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Kamryn T
KT
Eddy
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Anne
A
Klibanski
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.|Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Madhusmita
M
Misra
D015502:Absorptiometry, Photon; D000293:Adolescent; D000568:Amenorrhea / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D000856:Anorexia Nervosa / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001835:Body Weight / Q000502:physiology*; D015519:Bone Density / Q000502:physiology*; D002648:Child; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008598:Menstruation / Q000502:physiology*; D012720:Severity of Illness Index; D055815:Young Adult
adolescent; anorexia nervosa; bone; bone mineral density, low weight