Assessment of sex differences in bone deficits among adolescents with anorexia nervosa

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Abstract

<div class="section"> <a class="named-anchor" id="S1">  </a> <h5 class="section-title" id="d10530595e168">Objective:</h5> <p id="P2">The objective of this study was to compare sex differences in bone deficits among adolescents with anorexia nervosa (AN) and to identify other correlates of bone health. </p> </div><div class="section"> <a class="named-anchor" id="S2">  </a> <h5 class="section-title" id="d10530595e173">Method:</h5> <p id="P3">Electronic medical records of all patients 9–20 years of age with a DSM-5 diagnosis of AN who underwent dual-energy x-ray absorptiometry (DXA) scans within three months of initial evaluation by the eating disorders program at Stanford between March 1997 and February 2011 were retrospectively reviewed. Whole body bone mineral content Z-scores and bone mineral density (BMD) Z-scores at multiple sites were recorded using the Bone Mineral Density in Childhood Study (BMDCS) reference data. </p> </div><div class="section"> <a class="named-anchor" id="S3">  </a> <h5 class="section-title" id="d10530595e178">Results:</h5> <p id="P4">A total of 25 males and 253 females with AN were included, with median age 15 years (interquartile range [IQR] 14–17) and median duration of illness 9 months (IQR 5–13). Using linear regression analyses, no significant sex differences in bone deficits were found at the lumbar spine, total hip, femoral neck, or whole body when controlling for age, %mBMI, and duration of illness. Lower %mBMI was significantly associated with bone deficits at all sites in adjusted models. </p> </div><div class="section"> <a class="named-anchor" id="S4">  </a> <h5 class="section-title" id="d10530595e183">Discussion:</h5> <p id="P5">This is the first study to evaluate sex differences in bone health among adolescents with AN, using novel DSM-5 criteria for AN and robust BMDCS reference data. We find no significant sex differences in bone deficits among adolescents with AN except for a higher proportion of females with femoral neck BMD Z-scores <−1. Degree of malnutrition was correlated with bone deficits at all sites. </p> </div>

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Most cited references 19

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Epidemiology, course, and outcome of eating disorders.

Daphne van der A, Hans W. Hoek, Frédérique Smink (2013)

To review the recent literature about the epidemiology, course, and outcome of eating disorders in accordance with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The residual category 'eating disorder not otherwise specified' (EDNOS) was the most common DSM-IV eating disorder diagnosis in both clinical and community samples. Several studies have confirmed that the DSM-5 criteria for eating disorders effectively reduce the proportion of EDNOS diagnoses. The lifetime prevalence of DSM-5 anorexia nervosa among women might be up to 4%, and of bulimia nervosa 2%. In a cross-national survey, the average lifetime prevalence of binge eating disorder (BED) was 2%. Both anorexia nervosa and bulimia nervosa are associated with increased mortality. Data on long-term outcome, including mortality, are limited for BED. Follow-up studies of BED are scarce; remission rates in randomized controlled trials ranged from 19 to 65% across studies. On a community level, 5-year recovery rates for DSM-5 anorexia nervosa and bulimia nervosa are 69 and 55%, respectively; little is known about the course and outcome of BED in the community. Applying the DSM-5 criteria effectively reduces the frequency of the residual diagnosis EDNOS, by lowering the threshold for anorexia nervosa and bulimia nervosa, and adding BED as a specified eating disorder. Course and outcome studies of both anorexia nervosa and bulimia nervosa show that no significant differences exist between DSM-5 and DSM-IV definitions.

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Optimizing bone health in children and adolescents.

Neville H. Golden, Steven A. Abrams (2014)

The pediatrician plays a major role in helping optimize bone health in children and adolescents. This clinical report reviews normal bone acquisition in infants, children, and adolescents and discusses factors affecting bone health in this age group. Previous recommended daily allowances for calcium and vitamin D are updated, and clinical guidance is provided regarding weight-bearing activities and recommendations for calcium and vitamin D intake and supplementation. Routine calcium supplementation is not recommended for healthy children and adolescents, but increased dietary intake to meet daily requirements is encouraged. The American Academy of Pediatrics endorses the higher recommended dietary allowances for vitamin D advised by the Institute of Medicine and supports testing for vitamin D deficiency in children and adolescents with conditions associated with increased bone fragility. Universal screening for vitamin D deficiency is not routinely recommended in healthy children or in children with dark skin or obesity because there is insufficient evidence of the cost-benefit of such a practice in reducing fracture risk. The preferred test to assess bone health is dual-energy x-ray absorptiometry, but caution is advised when interpreting results in children and adolescents who may not yet have achieved peak bone mass. For analyses, z scores should be used instead of T scores, and corrections should be made for size. Office-based strategies for the pediatrician to optimize bone health are provided. This clinical report has been endorsed by American Bone Health.

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Epidemiology and course of anorexia nervosa in the community.

Anna Keski-Rahkonen, Jaakko Kaprio, Anu Raevuori … (2007)

Most previous studies of the prevalence, incidence, and outcome of anorexia nervosa have been limited to cases detected through the health care system, which may bias our understanding of the disorder's incidence and natural course. The authors sought to describe the onset and outcomes of anorexia nervosa in the general population. Lifetime prevalences, incidence rates, and 5-year recovery rates of anorexia nervosa were calculated on the basis of data from 2,881 women from the 1975-1979 birth cohorts of Finnish twins. Women who screened positive for eating disorder symptoms (N=292), their screen-negative female co-twins (N=134), and 210 randomly selected screen-negative women were assessed for lifetime eating disorders by telephone by experienced clinicians. To assess outcomes after clinical recovery and to detect residua of illness, women who had recovered were compared with their unaffected co-twins and healthy unrelated women on multiple outcome measures. The lifetime prevalence of DSM-IV anorexia nervosa was 2.2%, and half of the cases had not been detected in the health care system. The incidence of anorexia nervosa in women between 15 and 19 years of age was 270 per 100,000 person-years. The 5-year clinical recovery rate was 66.8%. Outcomes did not differ between detected and undetected cases. After clinical recovery, the residua of illness steadily receded. By 5 years after clinical recovery, most probands had reached complete or nearly complete psychological recovery and closely resembled their unaffected co-twins and healthy women in weight and most psychological and social measures. The authors found a substantially higher lifetime prevalence and incidence of anorexia nervosa than reported in previous studies, most of which were based on treated cases. Most women recovered clinically within 5 years, and thereafter usually progressed toward full recovery.