Management of ischiopubic stress fracture in patients with anorexia nervosa and excessive compulsive exercising

BMJ Case Rep. 2014 Oct 9:2014:bcr2014206393. doi: 10.1136/bcr-2014-206393.


This case report describes a 28-year-old non-athlete female patient with anorexia nervosa who was diagnosed with an ischiopubic ramus stress fracture and treated successfully as an inpatient with a cognitive behaviour-based therapy. The patient's clinical picture, diagnosis and treatment are described, and a brief review of the relevant literature is included. The importance of this case report stems from the rarity of descriptions of this kind of injury in such patients, despite their inherent risk, and the originality of the treatment applied. This, in addition to the usual approach to medical management, exploited specific cognitive and behavioural procedures and strategies to address the patient's excessive compulsive exercising, promoting rest and movement avoidance in order to allow the fracture to heal, while simultaneously addressing the underlying psychopathology.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anorexia Nervosa / complications*
  • Compulsive Behavior / complications*
  • Exercise* / psychology
  • Female
  • Fractures, Stress / etiology*
  • Humans
  • Pubic Bone / pathology*