Background: Anorexia nervosa is associated with an increased risk of fracture in women, but the association is unclear in men. We assessed the association between anorexia nervosa and the later risk of fracture hospitalization for men and women separately.
Methods: We performed a longitudinal cohort study of 7,332 patients with anorexia nervosa in Quebec, Canada, matched with 73,215 healthy controls between 1989 and 2023. The exposure was anorexia nervosa requiring inpatient treatment. Outcomes included severe fractures requiring admission for surgical reduction or fixation anytime after the anorexia nervosa admission. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for the association of anorexia nervosa with risk of fracture hospitalization stratified by sex.
Results: Patients with anorexia nervosa had higher fracture rates than controls, including men (74.0 vs. 39.9 per 10,000 person-years) and women (47.6 vs. 21.0 per 10,000 person-years). Compared with matched controls, men with anorexia nervosa were 1.86 times more likely to be hospitalized for fractures (95 % CI 1.34-2.58), while women were 2.26 times more likely (95 % CI 2.02-2.51). Anorexia nervosa was associated with fractures of the femur, humerus, and thoracic/shoulder/pelvic bones. Anorexia nervosa was strongly associated with osteoporotic fractures (HR 7.50, 95 % CI 5.62-10.01).
Conclusion: Anorexia nervosa is associated with an increased risk of pathologic fractures up to 34 years later. The association is present for both men and women.
Keywords: Anorexia nervosa; Eating disorder; Fracture; Osteoporosis; Sex differences.
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