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:
- 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.
Without the necessary treatment interventions, a person who has suffered with an eating disorder may develop severe bone loss lead to osteoporosis, regardless of their age. This is one of the difficult consequences resulting from eating disorders that is not fully reversible.
How Eating Disorders and Bone Loss Are Related
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. The slightest, most unexpected movement or event might trigger a fracture or broken bone in a woman recovering from an eating disorder who has osteoporosis.
They might notice that they are 3 or more inches shorter than they used to be because their spinal columns have collapsed on themselves. It is important not to ignore these changes, which are often red flags for a more severe underlying issue.
This can result in symptoms like:
- 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
- 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
Low 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
- Type-1 procollagen carboxy terminal propeptides
- Serum type-1 collagencarboxy-terminall 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.
An eating disorder specialist, such as a physician, can order a DEXA scan if it is suspected that a person recovering from an eating disorder is at risk for osteopenia or osteoporosis.
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.
Going over the details of the DEXA scan with an eating disorder treatment team can be helpful in formulating a comprehensive care plan to address any bone loss concerns and prevent further damage in the future.
Reversing the Course of Bone Loss
Once we recognize the problem, we need to act to reverse the course of bone loss. While not all bone loss can be reversed, some of the damage can be minimized while preventing further bone loss damage in the body. Addressing the root of the problem, which is the eating disorder, is essential to reversing the course of bone loss and healing from osteoporosis.
The first step is to stop the eating disordered behaviors, of which there are several options:
- Intensive outpatient Program (IOP)
- Partial hospitalization program
- Residential eating disorder program
- Inpatient level of care in a hospital
Deciphering which treatment option is most appropriate can be determined by having a complete evaluation and full eating disorder assessment with a specialist.
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. Connecting to the appropriate interventions for eating disorder recovery can be invaluable for restoring overall health and promoting healing from the inside-out.
Article Contributed by Staff of The Meadows Ranch:
For over 25 years, The Meadows Ranch has offered an unparalleled depth of care through its unique, comprehensive, and individualized program for treating eating disorders and co-occurring conditions affecting adolescent girls and women. Set on scenic ranch property in the healing landscape of Wickenburg, Arizona, The Meadows Ranch allows for seamless transitions between its structured multi-phase treatment.
- Gurze Books on www.bulimia.com. Osteoporosis and eating disorders. (accessed April 5, 2012).
- U.S. Department of Health & Human Services on www.niams.nih.gov. What people with anorexia nervosa need to know about osteoporosis. (accessed April 5, 2012).
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.
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.
Recently Reviewed By: Jacquelyn Ekern, MS, LPC on July 2, 2018
Edited & Updated by Crystal Karges, RD on August 24, 2017