Bone Density, Abnormalities and Early-Onset Anorexia

Young girl wanting to be a model not realizing of the weight stigma that comes with it

While many people assume bone conditions like osteoporosis only affect older populations, research shows that bone problems like osteoporosis are a common problem among individuals with anorexia nervosa. In fact, a recent study reveals children and adolescents with early-onset anorexia nervosa are at an increased risk of developing bone density abnormalities that could, if left untreated, lead to severe and permanent bone damage [1].

Bone Density Abnormalities and Anorexia

Low bone mineral density is a common problem among individuals with eating disorders, especially those with restrictive eating disorders like anorexia nervosa (AN). While several different factors cause individuals with eating disorders to develop bone density problems, the short version is that the body alters its hormone production in response to malnourishment and low body weight. This change in hormones reduces the number of minerals in a person’s bones, causing them to become brittle, weak, and susceptible to fractures and more serious, long-term problems like osteoporosis.

One study reports that 20 to 30 percent of anorexia patients are diagnosed with osteoporosis, while 50 to 90 percent suffer from osteopenia (brittle and weak bones from loss of bone mass often leading to osteoporosis) [2]. In summary, low bone density is a serious problem among individuals with eating disorders, often leading to chronic pain, bone fractures, disability, loss of stature, and conditions like osteopenia and osteoporosis.

Early-Onset Anorexia Nervosa and Bone Density Problems

While anyone with an eating disorder is at risk of developing bone density abnormalities, a recent study shows that children and young people who develop anorexia before the age of 14 (i.e. early-onset anorexia) are especially vulnerable to bone density problems [3]. The study, conducted by researchers at the Robert Debré Paediatric Hospital in Paris, France, included 67 female patients with early-onset AN and 67 healthy, age-comparable control subjects.

Each of the 67 female patients with EO-AN was between 10.9 and 13.7 years old, had suffered from anorexia for a median duration of 1.3 years, and had been hospitalized at the Child and Adolescent Psychiatry Department of Robert Debré Paediatric Hospital (Paris, France) at some point between 2010 and 2015.

After extensive study, the researchers discovered that every element of bone quality was lower in EO-AN patients compared to the healthy controls. Specifically, Total Body Bone Mineral Density, Total Body Bone Mineral Content, Lumbar Spine Bone Mineral Density, and Ratio of the Total Body Bone Mineral Content to Lean Body Mass were all found to be significantly lower in patients with EO-AN than control subjects [4].

Additionally, the study revealed that the lumbar spine is more seriously affected by EO-AN than cortical bone (the outer surface of the bone that comprises roughly 80 percent of skeletal mass). This means young people with early-onset anorexia are at an increased risk of developing severe back pain, lost height/stunted growth, hunched posture, and bone fractures in their spine or hip.

Girl laying grass with flowers glad to not deal with bone density issuesImportant to note here is that many experts believe the length of the illness is a defining factor in the development of bone density loss. In other words, it is assumed that individuals who have suffered from an eating disorder for several years are at a much higher risk of developing bone density problems than those who only recently developed an ED.

This often means young people and those who recently developed an ED are not properly screened for bone density abnormalities. As a result, bone density loss often goes undetected and undiagnosed in ED patients until a severe injury (e.g., spine or hip fracture) occurs. By this point, the problem has often escalated to a serious condition like osteopenia or osteoporosis.

But as this study reveals, young people with early-onset anorexia nervosa display severe bone density problems and are at risk of developing conditions like osteopenia and osteoporosis, despite their relatively short duration of illness (in the case of the study’s EO-AN patients, less than two years). The researchers contend that, since late childhood and early adolescence is a critical time for bone accrual, these findings should not come as a surprise. In fact, they go on to say that girls typically experience peak bone mass gain during late puberty, meaning any bone mineral deficiencies occurring before or during this time can lead to permanent damage [5].

The Importance of Addressing Bone Health in ED Treatment

Given that eating disorders like anorexia have a direct impact on bone mineralization and that late childhood and early adolescence is a critical time for bone development, doctors and ED specialists should make bone health a priority when treating young people with early-onset anorexia. By detecting and treating bone density abnormalities early on, patients may avoid serious and irreversible complications like fractures, chronic pain, disability, loss of stature, and even osteoporosis.


References:

[1] Clarke, J., Peyre, H., Alison, M. et al. Abnormal bone mineral density and content in girls with early-onset anorexia nervosa. J Eat Disord 9, 9 (2021). https://doi.org/10.1186/s40337-020-00365-6

[2] Legroux, I., & Cortet, B. (2019, November 1). Factors influencing bone loss in anorexia nervosa: assessment and therapeutic options. RMD Open. https://rmdopen.bmj.com/content/5/2/e001009.

[3] Clarke, J., Peyre, H., Alison, M. et al. Abnormal bone mineral density and content in girls with early-onset anorexia nervosa. J Eat Disord 9, 9 (2021). https://doi.org/10.1186/s40337-020-00365-6

[4] ibid.

[5] ibid.


About the Author:

Sarah Musick PhotoSarah Musick is a freelance writer who specializes in eating disorder awareness and education. After battling with a 4-years long eating disorder, she made it her mission to help others find hope and healing in recovery.

Her work has been featured on numerous eating disorder blogs and websites. When she’s not writing, Sarah is off traveling the world with her husband.


The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a 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 February 18, 2021, on EatingDisorderHope.com
Reviewed & Approved on February 18, 2021, by Jacquelyn Ekern MS, LPC

About Baxter Ekern

Baxter is the Vice President of Ekern Enterprises, Inc. He is responsible for the operations of Eating Disorder Hope and ensuring that the website is functioning smoothly.