Abstract
Abstract
Background
Lower bone mineral density (BMD) increases the risk of osteoporosis in individuals with eating disorders (EDs), particularly women with anorexia nervosa (AN), making them susceptible to pain and fractures throughout adulthood. In AN, low weight, hypothalamic amenorrhoea, and longer illness duration are established risk factors for low BMD, and in people with other EDs a history of AN seems to be an important risk factor for low BMD.
Purpose
To conduct a systematic review and meta-analysis of BMD in individuals with EDs, including AN, bulimia nervosa (BN), binge-eating disorder (BED) and other specified feeding or eating disorders (OSFED) compared to healthy controls (HC).
Methods
Following PRISMA guidelines, electronic databases were reviewed and supplemented with a literature search until 2/2022 of publications measuring BMD (dual-energy X-ray absorptiometry or dual photon absorptiometry) in females with any current ED diagnosis and a HC group. Primary outcomes were spine, hip, femur and total body BMD. Explanatory variables were fat mass, lean mass and ED clinical characteristics (age, illness duration, body mass index (BMI), amenorrhoea occurrence and duration, and oral contraceptives use).
Results
Forty-three studies were identified (N = 4163 women, mean age 23.4 years, min: 14.0, max: 37.4). No study with individuals with BED met the inclusion criteria. BMD in individuals with AN (total body, spine, hip, and femur), with BN (total body and spine) and with OSFED (spine) was lower than in HC. Meta-regression analyses of women with any ED (AN, BN or OSFED) (N = 2058) showed low BMI, low fat mass, low lean mass and being amenorrhoeic significantly associated with lower total body and spine BMD. In AN, only low fat mass was significantly associated with low total body BMD.
Conclusion
Predictors of low BMD were low BMI, low fat mass, low lean mass and amenorrhoea, but not age or illness duration. In people with EDs, body composition measurement and menstrual status, in addition to BMI, are likely to provide a more accurate assessment of individual risk to low BMD and osteoporosis.
Funder
Fundação de Amparo à Pesquisa do Estado de São Paulo
National Institute of Health Research
Publisher
Springer Science and Business Media LLC
Subject
Behavioral Neuroscience,Psychiatry and Mental health,Nutrition and Dietetics
Reference97 articles.
1. APA APA. Fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5). 2013;21.
2. Herpertz-Dahlmann B. Adolescent eating disorders: update on definitions, symptomatology, epidemiology, and comorbidity. Child Adolesc Psychiatr Clin N Am. 2015;24(1):177–96. https://doi.org/10.1016/j.chc.2014.08.003.
3. Misra M, Klibanski A. Anorexia nervosa and its associated endocrinopathy in young people. Horm Res Paediatr. 2016;85(3):147–57. https://doi.org/10.1159/000443735.
4. Kanis JA, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2019;30(1):3–44. https://doi.org/10.1007/s00198-018-4704-5.
5. Escalante Boleas M, Franco Vicario R, Bustamante Murga V, Miguel de la Villa F. Bone metabolism and bone mass loss in eating disorders. An Med Interna. 2002;19(3):143–50.