Anorexia, Bone Density Concerns & Vitamin D

Girl Developing an Eating Disorder

Osteoporosis and bone loss are a severe physical consequence that can occur quickly within the early stages of an eating disorder. Getting a bone density scan and medical consult can help you identify if this is an issue you need to address.

Defining Anorexia

Anorexia is an eating disorder that includes irrational fear of gaining weight. Sufferers are often underweight and restrict food intake through starvation, over-exercise and sometimes purging behaviors. Individuals become obsessed with food and can result in serious physical and medical issues including decreased bone density and vitamin D deficiencies.

Osteoporosis Defined

Osteoporosis is when the bones are less dense and can fracture. This can result in significant pain and disability. More than 53 million individuals in the U.S. are diagnosed with osteoporosis or at high risk due to low bone mass [1].

Risk factors for the development of this disease are thinness, family history of osteoporosis, being without a menstrual cycle or menopause, low calcium intake, smoking, significant alcohol intake, and lack of exercise. Often bone loss is associated with underweight women.

Connecting Anorexia and Osteoporosis

Anorexia has serious physical consequences. A person can have both nutritional and hormonal shifts that can impact their bone density. Low body weight in women can stop estrogen production, and cause amenorrhea or lack of menstrual cycles. This can contribute to a massive loss in bone density, leading to osteoporosis [1].

The adrenal hormone, cortisol, is also excessively produced in those with anorexia, which also can lead to bone loss.

Woman struggling with osteoporosis and bone densityOther factors such as a decrease in the growth hormone coupled with low body weight, low calcium and malnutrition can aid in bone loss and osteoporosis and osteopenia diagnosis.

Bone loss occurs early within anorexia and can cause a person to not reach their peak bone density and increase the risk of bone fractures later in life.

Previous research suggests that low bone density is common in people with anorexia and that bone loss starts decreasing in the early stages of the disease.

Adolescents and children aged 9 and older anorexia may be less likely to reach their optimum bone density and thus may be at higher risk for osteoporosis and fractures throughout life.

What To Do

1/3rd of our bone density is achieved during the puberty process [2]. This is critical for bone development, and the longer anorexia continues, the greater the bone loss and decrease in bone mineral which can affect lifelong bone strength.

Vitamin D comes into play to help reverse bone loss with anorexia. It is important to have high calcium foods, such as dairy products, dark leafy vegetables, and calcium-fortified foods and beverages.

Often calcium supplements are used with those who have anorexia to make sure that they are receiving the recommended daily amounts. Other foods that can increase Vitamin D include egg yolks, saltwater fish, and liver. Supplements in Vitamin D are also used for recommended daily intake.

A study found that Vitamin D deficiency is significantly prevalent in teens who have an eating disorder [2]. This increases the risk for osteoporosis, cessation of estrogen, and increased cortisol levels, all which contribute to bone loss.

Another study in Israel found that participants in their early to late teen years who had anorexia, bulimia, and binge eating, measured the vitamin D levels and bone mineral density were lower than 32 ng/ml, which is the level where bone growth is maintained. It was also found that the lumbar spine bone mineral density was also low [2].

We know that body changes in low weight or malnutrition affect hormone production. Oestrogen is also decreased which affects menstruation in women and cortisol is increased. With weight loss comes poor nutrition and can also contribute to reduced muscle mass.

Treatment Considerations

Treatment includes support from a multi-disciplinary team to include, a medical provider, psychiatrist, individual therapist, and dietician [3]. Bone density scans, vitamin supplements are often required.

HIgh school girl struggling with eating disorder

Birth control can also be used to help with estrogen replacement and improving bone density but can affect growth levels in children as it can influence the natural process of bone formation and growth [3].

It is typically recommended that exercise and weight training be used for strengthening bones but with anorexia, it is difficult as the goal is for weight gain. Exercise can be utilized once weight is restored with nutritional support and supervision.

It can take up to one year for complex medical conditions to rectify and many sufferers go onto to have lower bone density in the long term depending on the duration and severity of the eating disorder.

Final Thoughts

Eating disorders are directly related to bone density concerns and loss of vitamin D and calcium. Lack of poor nutrition through starvation, rapid weight loss, and cessation of the menstrual cycle can decrease bone strength.

Even though other eating disorders do not include starvation, lack of proper nutrition and exercise can trigger bone loss to begin. Through working with your treatment team, and following medical recommendations, you can slowly regain bone strength and reverse some of the physical damage done by the eating disorder.

Image of Libby Lyons and familyAbout the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.

Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.


[1] What People With Anorexia Nervosa Need to Know About Osteoporosis. (n.d.). Retrieved September 06, 2017, from
[2] Vitamin D deficiency and low bone mass found in adolescents with eating disorders. (n.d.). Retrieved September 06, 2017, from
[3] National Osteoporosis Society . (2014). Anorexia nervosa and osteoporosis. Retrieved September 6, 2017, from

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on October 17, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on October 17, 2017.
Published on