Premenopausal osteoporosis, an overlooked consequence of anorexia nervosa

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  • Weight restoration and nutritional rehabilitation remain the keys to treatment of low bone density to reduce the risk of osteoporosis in patients with anorexia nervosa. However, as many as one-third of patients with anorexia nervosa relapse during their lifetime, and other treatments are needed to stabilize and prevent bone loss.
  • Vitamin D deficiency is clearly associated with a risk of osteoporosis and fracture, and patients with vitamin D deficiency should be treated with supplementation.
  • Standard therapies in postmenopausal patients (such as bisphosphonates and teriparatide) should be used with caution in premenopausal anorexia nervosa patients because of potential long-term health risks.
  • Although treatment of amenorrhea and estrogen deficiency has been shown to at least stabilize bone density in postmenopausal patients, this does not appear to be the case in premenopausal girls and young women.
  • As we learn more about hormonal factors in anorexia nervosa, we hope to identify interventions that will help restore weight and decrease the risk of osteoporosis. A summary of potential treatment strategies and targets for prevention of osteoporosis in anorexia nervosa is presented in Table 2.

Acknowledgment: The author thanks the General Internal Medicine Works in Progress Group for its editorial comments, and Dr. Ellen Rome for her mentorship and support.

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