Bone Density Abnormalities from Early-Onset Anorexia Nervosa


Early-Onset Anorexia & Bone Health

Anorexia nervosa can majorly impact someone’s physical and mental health. There’s a wide range of medical complications that can pop up as a result of anorexic behaviors. In fact, anorexia can impact every major organ system in the body, including the musculoskeletal system. Know what this system controls? Bones!

What’s Early-Onset Anorexia Nervosa?

Anorexia nervosa is an eating disorder characterized by severe food restriction and weight loss. Restriction is motivated by an intense fear of gaining weight or becoming fat. Some people with anorexia may also use other disordered behaviors to lose weight, like abusive exercise, purging, or laxative abuse.

Early-onset anorexia (EO-AN) is when someone develops anorexia before age 14 and before having their first menstrual period [1]. While anorexia is concerning regardless of age, it’s especially concerning during puberty. The body is going through massive change during this stage of development.

Most people with anorexia begin showing signs during the teenage years or early adulthood [1]. Even though the disorder will look similar despite how old someone is, the medical complications can be different depending on age.

How Does Early-Onset Anorexia Impact Bone Health & Why This Matters

Recent research shows that anorexia impacts bone health. Severe food restriction can impact hormones. This hormonal disruption can then impact bone health because the bones aren’t getting the nutrients they need [1]. In fact, some people with anorexia develop osteoporosis as a result of their eating disorder.

This can impact anyone with anorexia regardless of age. But, research shows that people dealing with EO-AN can experience more severe damage to their bones than older people with the disorder [1]. This is really concerning because for optimal bone health throughout your lifetime, your bone mass needs to peak during adolescence [1]. In order for this to happen, puberty needs to occur. Anorexia can interfere with puberty which basically stunts someone’s physical development [1].

For people dealing with EO-AN, their bones don’t have a chance to grow as much as they should [1]. This can place someone at an increased risk for dealing with pain and fractures throughout their life [1]. While broken bones may not seem like a big deal, over time it can become a huge problem especially as someone gets older.

During adolescence, it can be isolating and depressing to not be able to participate in certain activities because of broken bones or physical limitations resulting from low bone density. As someone gets older, they may be more at risk of severe bone fractures, like a broken hip. Fractures like this can prevent someone from being able to live independently. This can drastically impact someone’s quality of life.

Girl looking at mountains

How Can People With Early-Onset Anorexia Get Treatment for Bone Abnormalities?

Treatment for anorexia should include medical and psychological treatment. Someone dealing with EO-AN can benefit from medical interventions to support bone health. These may include the following interventions:

  • Monitoring for bone density through medical tests
  • Nutritional interventions to support increased vitamin and mineral consumption, specially the vitamins that directly benefit bones
  • Medically supervised exercise. Exercise is important for bone health, but people with anorexia and bone density abnormalities need support in doing safe exercise.
  • Education about avoiding substances, such as steroids, alcohol, and nicotine, that can negatively affect bone density [1,2]

How Can We Prevent Early-Onset Anorexia?

There’s a lot that can feed into someone developing anorexia. However, there are prevention strategies that have proven to be effective. Some examples of prevention strategies are:

  • Screening for eating disorder symptoms and risk factors. This can help professionals refer to treatment early and continue to monitor for symptoms if someone is showing risk factors
  • Body positive and intuitive eating campaigns. Teaching young girls and adolescents about body positivity and intuitive eating can help them think critically about the messages that are fed to them through the media about body image and dieting
  • Mental health counseling for youth who are showing signs of disordered eating or negative body image [3].

The emotional and psychological impact of anorexia is significant. This impact alone should push us to want to prevent and more effectively treat this disorder. When you add the medical complications to the list, the need for effective treatment becomes even more important. If you or your loved one is struggling, reach out for help today. Eating Disorder Hope has a treatment finder that can help you find eating disorder treatment near you.


[1] Clarke, J., Peyre, H., Alison, M., Bargiacchi, A., Stordeur, C., Boizeau, P., Mamou, G., Guilmin-Crépon, Alberti, C., Léger, J., & Delorme, R. (2021). Abnormal bone mineral density and content in girls with early-onset anorexia. Journal of Eating Disorders, 9(9), 1-8.

[2] Michigan Medicine. (2020, December 7). Low Bone Density. University of Michigan.

[3] National Eating Disorders Association. (2021) Prevention.

About the Author:

Samantha Bothwell PhotoSamantha Bothwell, LMFT, is a licensed Marriage and Family Therapist, writer, explorer, and lipstick aficionado. She became a therapist after doing her own healing work so she could become whole after spending many years living with her mind and body disconnected. She has focused her clinical work to support the healing process of survivors of sexual violence and eating disorders. She is passionate about guiding people in their return to their truest Self so they can live their most authentic, peaceful life.

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 June 10, 2021, on
Reviewed & Approved on June 10, 2021, by Jacquelyn Ekern MS, LPC