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Bone Loss From Eating Disorders

Article contributed by Staff of Remuda Ranch

Osteoporosis from Bone Loss From Eating Disorders

When we think of the medical stabilization of patients with eating disorders, we tend to focus on the immediate pressing concerns:

  • Abnormal cardiac function from blood chemistry imbalances that can lead to sudden death
  • Gastrointestinal bleeds from repeated vomiting
  • Seizures from low blood sugar
  • Other physical health concerns

Once we stabilize the malnourished patient, we need to address long-term consequences of the eating disorder that may lead to dire consequences if unaddressed.

This is particularly true for severe bone loss known as osteopenia in its earlier, less severe stage and osteoporosis in its later more critical stage.

The Dangers of Osteoporosis

Osteoporosis is a silent, but extremely, disabling, painful condition, involving severe bone loss that can lead to:

  • Disability
  • Chronic pain
  • Loss of stature
  • Bone fractures

It is a significant health concern for 44 million Americans, and 70% of those at risk are women.  Most people think of osteoporosis as a condition of the elderly. It tends to be ignored as a potential problem in patients with anorexia or bulimia nervosa, most of whom developed their disorder in their teens or early twenties.

This is a mistake.  Even if they are in recovery, they are at a greater risk of suffering osteoporosis that in many cases could have been avoided or minimized with preventative treatment.

Women with eating disorders, particularly Anorexia Nervosa, are at high risk for osteoporosis.  About three-quarters of women who meet the criteria for anorexia nervosa (those who are 85% or less of their ideal body weight), show some evidence of bone mineral deficiency.

About half of them, even after they restore their weight, resumed their menses and are within a healthy weight range, still might go on to develop osteoporosis.  These women have brittle bones.

They might not know that they have a problem until they fall and break a hip and need joint replacement.  Their bones might collapse upon themselves and cause excruciating, constant pain.

They might notice that they are 3 or more inches shorter than they used to be because their spinal columns have collapsed on themselves.

This can result in symptoms like:

  • Numbness
  • Weakness
  • Chronic pain

How Osteoporosis Develops

Bones are in a state of constant flux.  Old bone is reabsorbed and new bone is laid down by bone cells called osteocytes.  During childhood and early adolescents in women, sometime after the onset of menses in puberty, the osteocytes lay down new bone faster than it is being absorbed, reaching peak bone mass at about 15 years of age.

Bone production slows down but continues to about age 30; after that, bone mass shrinks about 1% annually.

This rate of bone loss can be accelerated by such factors as:

  • Family history
  • Smoking
  • Sedentary lifestyle
  • Overly strenuous exercising
  • Certain medications
  • Inadequate nutrition
  • Hormonal imbalances

Patients with eating disorders trigger hormonal changes by being malnourished.

The body responds to malnutrition by trying to conserve resources: 

  • Menses stop
  • Body core temperature drops
  • The heart slows down
  • Estrogen levels fall

Early Onset Osteoporosis

Woman fighting osteoporosisLow estrogen, particularly important in children and adolescents who are still growing, leads to a decrease in bone production and an increase in bone absorption.

Early-onset eating disorders in pre-pubertal patients can lead to permanently stunted growth and a predisposition to osteoporosis later in life.

Because being in a state of starvation is stressful, the brain triggers a red alert to the rest of the body in the form of elevated levels of cortisol pumped out by the adrenal glands that also accelerate bone absorption.

Catching Eating Disorders and Bone Loss Early

Recognizing the problem early on is crucial to treating osteoporosis.

There are laboratory tests available, which measure:

  • Serum estrodial
  • Calcitonin
  • Type-1 procollagen carboxy terminal propeptides
  • Serum type-1 collagen carboxy terminal telopeptide

The best diagnostic tool for patients at high risk for bone loss is to measure bone density using a special x-ray test known as a DEXA (dual energy x-ray absorptiometry) scan of the hip and lower spine.  This test is reliable, rapid, and painless.

Sometimes getting the results of a DEXA scan is concrete data that can help the patient recognize the damage that the eating disorder is doing to her body. She might then realize that she needs to accept help or the problem will only get worse.

Reversing the Course of Bone Loss

Once we recognize the problem, we need to act to reverse the course of bone loss.

The first step is to stop the eating disordered behaviors, of which there are several options:

Subsequent treatment would involve weight restoration, calcium and vitamin D supplementation, and possibly supervised muscle strengthening.  In the future, patients would be encouraged to maintain their weight and eat food rich in calcium, such as yogurt, Swiss cheese, fortified milk, and dried figs.

They should also get vitamin D through modest exposure to sunlight or multivitamins.  Once they restore to normal weight, they could perform a moderate exercise like walking, gardening, or yoga that should not be allowed to progress to compulsive, prolonged strenuous exercise.

Why Prevention Is so Important

While osteoporosis is a severe problem in patients with eating disorders, bone loss if recognized early can be addressed and potentially reversed. However, once the patient does develop osteoporosis, there is currently no cure for it.  The key is recognizing the problem early and taking decisive steps to address the bone loss before things go too far.

Eating disorders are already such a devastating problem.  It would be an insult upon injury to suffer further losses to one’s health, function, and well-being, years after the precipitating eating disorder was recognized and supposedly addressed.  Fortunately, it does not have to be this way.

Helpful References:

  1. Gurze Books on Osteoporosis and eating disorders.  (accessed April 5, 2012).
  2. U.S. Department of Health & Human Services on What people with anorexia nervosa need to know about osteoporosis.  (accessed April  5, 2012).


Last reviewed and updated: By Jacquelyn Ekern, MS, LPC on May 5, 2017

Article Contributed by our Sponsor ~ Remuda Ranch Treatment Center

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