Osteoporosis in anorexia nervosa: the influence of peak bone density, bone loss, oral contraceptive use, and exercise

J Bone Miner Res. 1992 Dec;7(12):1467-74. doi: 10.1002/jbmr.5650071215.


Anorexia nervosa occurs early in life and predisposes to osteoporosis. Exercise may be protective. We asked: (1) Does failure to attain peak bone density contribute to the deficit in bone density? (2) Does oral contraceptive use protect against osteoporosis? (3) Is any protective effect of exercise confined to weight-bearing sites? Areal bone density (g/cm2) and body composition were measured by dual x-ray absorptiometry in 65 patients with anorexia nervosa and 52 controls. Comparing the 12 patients with primary amenorrhea and the 37 patients with secondary amenorrhea, bone density (mean +/- SEM) at the lumbar spine was 0.88 +/- 0.04 versus 1.06 +/- 0.03 (P = 0.001), respectively. Bone density at the femoral neck was 0.80 +/- 0.04 versus 0.92 +/- 0.03 (P < 0.05), respectively. These values differed before, but not after, adjusting for the respective duration of illness (73.0 +/- 10.3 versus 34.1 +/- 4.8 months, P < 0.001) and fat-free mass (31.6 +/- 1.3 versus 35.4 +/- 0.5 kg, P < 0.01). Bone density at the lumbar spine in the 16 patients with 31.8 +/- 8.3 months of contraceptive exposure was higher than in the 49 patients with no contraceptive exposure (1.14 +/- 0.05 versus 1.02 +/- 0.02 P < 0.02) but was lower than in controls (1.14 +/- 0.05 versus 1.27 +/- 1.02, P < 0.01). No protective effect of contraceptive exposure was detectable at the femoral neck.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: In Australia, a group of 65 patients with anorexia nervosa were studied. The diagnosis was based on DSM-III-R criteria. A total of 12 patients had primary amenorrhea. Of the 53 patients with secondary amenorrhea, 16 had taken oral contraceptives during a illness. A total of 19 patients were exercisers. 52 premenopausal healthy women volunteers with no illnesses known to affect bone were studied as the control group. Total-body and regional bone density (lumbar spine, L2-4, femoral neck, Ward's triangle, and intertrochanteric regions) were measured by dual x-ray absorptiometry. The 65 patients with anorexia nervosa had significantly lower bone density (lumber spine 1.05 +or- 0.02 gm/sq cm, femoral neck 0.91 +or- 0.02 gm/sq cm), weight (43.3 +or- 0.9 kg), fat mass (7.01 +or- 0.57 kg), and fat-free (lean) mass (34.89 +or- 0.53 kg) than controls (all p 0.001), even after adjustments for differences in age (24.4 +or- 1.0 years, and height, 162.5 +or- 0.8 cm). In the 12 patients with primary amenorrhea, the reduction in bone density at the lumbar spine and femoral neck was greater than the reduction at the corresponding sites in the 37 patients with secondary amenorrhea (p = 0.001 and p = 0.04, respectively). A total of 16 patients took oral contraceptives for 61 +or- 9% of the duration of their illness whose mean bone density at the lumbar spine was greater than in the 49 patients without contraceptive exposure (p 0.01) but less than in controls (p 0.01). The 19 patients who exercised vigorously had higher bone density at the proximal femoral sites than sedentary patients. Patients with anorexia nervosa commencing around puberty may be at greater risk for fractures because they have lower bone density. A protective effect of oral contraceptives was found at the spine; a protective effect of weight-bearing exercise was found at the proximal femur. Thus, estrogen replacement therapy may be an important therapeutic option in this illness.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon
  • Adult
  • Amenorrhea / etiology
  • Amenorrhea / physiopathology
  • Anorexia Nervosa / complications*
  • Anorexia Nervosa / physiopathology
  • Body Composition
  • Bone Density*
  • Contraceptives, Oral / pharmacology*
  • Exercise*
  • Female
  • Femur
  • Humans
  • Lumbar Vertebrae
  • Osteoporosis / etiology*
  • Osteoporosis / physiopathology
  • Regression Analysis


  • Contraceptives, Oral