Bone Density

Decreased estrogen and progesterone secretion; low serum levels of IGF-1; increased levels of serum cortisol; malnutrition with protein, calcium, and vitamin deficiencies; and fatty degeneration of the bone marrow lead to decreased bone density. Increased exercising does not counteract this-osteo-penic tendency, which affects mostly young women during the years of skeletal growth. The osteopenia of anorexia nervosa is mostly asymptomatic, but some patients may present with stress fractures (diagnosed only with bone scans) related to their increased exercising. Many of these patients do not achieve their peak bone density even after their nutritional recovery and restoration of menses, and they are left with a propensity to fracture bones for the rest of their lives. Treatment with estrogens, calcium, and vitamin D is mildly effective. IGF-1 and DHEA-S have been used with partial success.

Rapid restoration of nutrition seems to be the best management of anorexic osteopenia.

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