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. 2017 Sep 29:4:46.
doi: 10.3389/fnut.2017.00046. eCollection 2017.

Bone Mineral Density after Weight Gain in 160 Patients with Anorexia Nervosa

Najate Achamrah  1   2   3 , Moïse Coëffier  1   2   3 , Pierre Jésus  2   3 , Jocelyne Charles  1 , Agnès Rimbert  1 , Pierre Déchelotte  1   2   3 , Sébastien Grigioni  1
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Bone Mineral Density after Weight Gain in 160 Patients with Anorexia Nervosa

Najate Achamrah et al. Front Nutr. .

Abstract

Low bone mineral density (BMD) is a frequent complication in anorexia nervosa (AN). There are controversial points of views regarding the restoration of bone mineralization after recovery in AN. We aimed to assess changes of BMD at 3 years in patients with AN and to explore the relationships between body composition, physical activity, and BMD. Patients with AN were included from 2009 to 2011 in a first visit (T0) with evaluation of weight, height, body mass index (BMI), body composition [fat mass (FM) and fat-free mass], and BMD. Those who had low BMD, either osteoporosis or osteopenia, were admitted in a second visit (T1) to carry out a new bone densitometry examination and body composition; they were also asked for their physical activity. At T0, our study involved 160 patients. Low BMD was observed in 53.6% of them and significant factors associated with demineralization were lower BMIs (16.5 ± 2.1 vs 17.3 ± 2.3 kg/m2, p = 0.01) and higher duration of AN (11.4 ± 10.5 vs 6.4 ± 6.5 years, p = 0.001). At 3 years follow-up (T1), 42 patients were involved and no significant changes in BMD were observed despite body weight increase (3.8 ± 6.1 kg). Interestingly, FM gain was a significant factor associated with BMD improvement at follow-up (8.0 ± 9.1 vs 3.0 ± 3.5 kg, p = 0.02). Our findings suggest that the restoration of normal bone values is not related to the increase of body weight, at least after 3 years. FM seems to play an important role in the pathophysiological mechanism of osteoporosis and osteopenia in AN.

Keywords: anorexia nervosa; body composition; bone mineral density; fat mass; osteoporosis.

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Figures

Figure 1
Figure 1
Percentage of anorectic patients according to bone mineral density (BMD) status changes. BMD status was followed in 42 anorexia nervosa (AN) patients. BMD status was classified as BMD loss (open bars), stable (gray bars), or improvement (black bars).
Figure 2
Figure 2
Percentage of anorectic patients according to bone mineral density (BMD) status at inclusion. BMD was evaluated in 160 anorexia nervosa patients who were classified as normal BMD (open bars), osteopenia (gray bars), and osteoporosis (black bars).
Figure 3
Figure 3
Flow chart. At T0, 160 patients with anorexia nervosa (AN) were involved in the study. Low bone mineral density (osteoporosis or osteopenia) was observed in 86 of those 160 patients. Since 26 patients refused to participate and 18 patients were lost, the second visit (T1) involved 42 patients with AN.
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