Vertebral Volumetric Bone Density and Strength are Impaired in Women with Low-weight and Atypical Anorexia Nervosa
Year: 2016
Type: article
Study design: Observational Study
Abstract: Context: Areal bone mineral density (BMD) is lower, particularly at the spine, in low-weight women with anorexia nervosa (AN). However, little is known about vertebral integral volumetric BMD (Int.vBMD) or vertebral strength across the AN weight spectrum, including "atypical" AN [body mass index (BMI) ≥18.5 kg/m2]. Objective: To investigate Int.vBMD and vertebral strength, and their determinants, across the AN weight spectrum. Design: Cross-sectional observational study. Setting: Clinical research center. Participants: 153 women (age 18 to 45): 64 with low-weight AN (BMI <18.5 kg/m2; 58% amenorrheic), 44 with atypical AN (18.5≤BMI<23 kg/m2; 30% amenorrheic), 45 eumenorrheic controls (19.2≤BMI<25 kg/m2). Measures: Int.vBMD and cross-sectional area (CSA) by quantitative computed tomography of L4; estimated vertebral strength (derived from Int.vBMD and CSA). Results: Int.vBMD and estimated vertebral strength were lowest in low-weight AN, intermediate in atypical AN, and highest in controls. CSA did not differ between groups; thus, vertebral strength (calculated using Int.vBMD and CSA) was driven by Int.vBMD. In AN, Int.vBMD and vertebral strength were associated positively with current BMI and nadir lifetime BMI (independent of current BMI). Int.vBMD and vertebral strength were lower in AN with current amenorrhea and longer lifetime amenorrhea duration. Among amenorrheic AN, Int.vBMD and vertebral strength were associated positively with testosterone. Conclusions: Int.vBMD and estimated vertebral strength (driven by Int.vBMD) are impaired across the AN weight spectrum and are associated with low BMI and endocrine dysfunction, both current and previous. Women with atypical AN experience diminished vertebral strength, partially due to prior low-weight and/or amenorrhea. Lack of current low-weight or amenorrhea in atypical AN does not preclude compromise of vertebral strength.
DOI: 10.1210/jc.2016-2099
Authors: Katherine N. Bachmann, Melanie Schorr, Alexander G. Bruno, Miriam A. Bredella, Elizabeth A. Lawson, Corey M. Gill, Vibha Singhal, Erinne Meenaghan, Anu V. Gerweck, Meghan Slattery, Kamryn T. Eddy, Seda Ebrahimi, Stuart L. Koman, James M. Greenblatt, Robert J. Keane, Thomas Weigel, Madhusmita Misra, Mary L. Bouxsein, Anne Klibanski, Karen K. Miller
Language: English
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: National Institutes of Health, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Center for Research Resources, NIH Clinical Center, National Center for Advancing Translational Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: Bone Metabolism and Body Composition in Young Athletes, G3253475534, Harvard Clinical and Translational Science Center (UL1), General Clinical Research Center, Growth Hormone and Cardiovascular Disease, GH, Cardiovascular Risk and Visceral Adiposity in Women, G5407161818, Biomechanics of the Vertebral Fracture Cascade, Biomechanics of Vertebral Fractures: The Framingham QCT Study, IGF-I and Bone Loss in Women with Anorexia Nervosa, Harvard Clinical and Translational Science Center (UL1), Hormonal Factors in the Treatment of Anorexia Nervosa, Harvard Clinical and Translational Science Center, Training Program in Endocrinology
OpenAlex ID: W2530944092