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Anorexia Nervosa and Osteoporosis: Pathophysiology and Treatment

Journal of Bone Metabolism 2019년 26권 3호 p.133 ~ 143
 ( Steinman Jeremy ) - University of Iowa Carver College of Medicine Department of Internal Medicine

 ( Shibli-Rahhal Amal ) - University of Iowa Carver College of Medicine Department of Internal Medicine


Anorexia nervosa (AN) affects 2.9 million people, many of whom experience bone loss and increased fracture risk. In this article, we review data on the underlying pathophysiology of AN-related osteoporosis and possible approaches to disease management. Available research suggests that low body weight and decreased gonadal function are the strongest predictors of bone loss and fractures in patients with AN. Additionally, other metabolic disturbances have been linked to bone loss, including growth hormone resistance, low leptin concentrations, and hypercortisolemia, but those correlations are less consistent and lack evidence of causality. In terms of treatment of AN-related bone disease, weight gain has the most robust impact on bone mineral density (BMD). Restoration of gonadal function seems to augment this effect and may independently improve BMD. Bisphosphonates, insulin-like growth factor 1 supplementation, and teriparatide may also be reasonable considerations, however need long-term efficacy and safety data.


Anorexia; Bone density; Feeding and eating disorders; Osteoporosis
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