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Prevalence and Predictive Factors for Regional Osteopenia in Women with Anorexia Nervosa

Steven Grinspoon, MD; Elizabeth Thomas, NP; Sarah Pitts, BA; Erin Gross, BA; Diane Mickley, MD; Karen Miller, MD; David Herzog, MD; and Anne Klibanski, MD
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Copyright ©2004 by the American College of Physicians


Ann Intern Med. 2000;133(10):790-794. doi:10.7326/0003-4819-133-10-200011210-00011
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Background: Anorexia nervosa is highly prevalent among young women.

Objective: To determine prevalence and predictive factors for regional bone loss.

Design: Prospective cohort analysis.

Setting: University hospital.

Patients: 130 women with anorexia nervosa.

Measurements: Dual-energy x-ray absorptiometry.

Results: The prevalence of osteopenia (−1.0 SD ≥ T-score > −2.5 SD) and osteoporosis (T-score ≤ −2.5 SD) was 50% and 13% for the anterior–posterior spine, 57% and 24% for the lateral spine, and 47% and 16% for the total hip, respectively. Bone mineral density (BMD) was reduced by at least 1.0 SD at one or more skeletal sites in 92% of patients and by at least 2.5 SD in 38% of patients. Weight was the most consistent predictor of BMD at all skeletal sites. Twenty-three percent of patients were current estrogen users, and 58% were previous estrogen users. Bone mineral density did not differ by history of estrogen use at any site.

Conclusions: Bone mineral density is reduced at several skeletal sites in most women with anorexia nervosa. Weight, but not estrogen use, is a significant predictor of BMD in this population at all skeletal sites.

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Summary for Patients

Bone Loss in Women with Anorexia Nervosa

Copyright ©2004 by the American College of Physicians

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