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The musculoskeletal system includes all the parts of your body that help you move, primarily your bones and muscles. Eating disorders can negatively impact this system. This post will focus on the relationship between eating disorders and bone and muscle health.
How Eating Disorders Affect Bone Health
There are several different kinds of eating disorder behaviors. However, when looking at the relationship between eating disorders and bone health, most research focuses on the impact of food restriction and bone health.
Food restriction is commonly seen in people with anorexia. Anorexia is an eating disorder characterized by an intense fear of gaining weight that leads people to severely limit the amount of food they eat. This leads to malnourishment.
The severe calorie deficit eventually can lead someone’s body to stop producing estrogen. Estrogen is necessary for healthy bone development. Without enough estrogen, this leads to a loss of bone mass .
While most people diagnosed with anorexia are girls and women, males also struggle with this disorder. For a male body, nutritional deficits can cause testosterone levels to drop. This increases the risk of bone mass loss .
For some people, this loss of bone mass can lead to osteoporosis. Osteoporosis is a medical condition where the bones are more likely to fracture.
Unfortunately, many people develop anorexia during adolescence. Adolescence is a critical time for bone development. If teens don’t have enough nutrition during this phase of development, they may fail to reach their peak bone density. This can set someone up for bone problems later in life.
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Risks for Athletes with Eating Disorders
As mentioned earlier, most people diagnosed with eating disorders are female. Female athletes with eating disorders are at an increased risk of problems with bone mass.
In fact, this problem is referred to as the “female athlete triad”. The female athlete triad refers to the connection between female athletes, osteoporosis, and eating disorders .
Research shows that in athletes with disordered eating, there is a shift in their brain chemistry that affects their hormone production. This is because they are exerting more energy than they are consuming, due to under-eating and the amount of exercise they are doing .
Athletes are at an increased risk of developing an eating disorder and osteoporosis due to the emphasis that some sports place on physical appearance and the pressure to win. The following factors also increase the risk that an athlete will develop disordered eating, which can lead to compromised bone health:
- Coaches who focus more on winning, rather than the athletes themselves
- Social pressure to be thin
- Family history of eating disorders
- Performance anxiety
- Sports that have a bodyweight category, like wrestling
- Sports that emphasize appearances, such as ballet or figure skating
- Low self-esteem
- History of physical or sexual abuse
- Overtraining or compulsive exercise 
It’s important to support athletes in establishing a relationship with their bodies and exercise that is based on having fun, enjoying the competition, and getting their physical needs met.
This can be more difficult for elite athletes. Even then, it’s important to support these individuals in having a healthy relationship with food and their body. Getting the physical and emotional nourishment necessary to compete at this level is necessary in preventing disordered eating.
It may also help to have coaches trained in how to identify disordered behaviors in their athletes. This can add an extra layer of support because if coaches can see when someone is struggling, they can refer them to get help more quickly.
Eating Disorders and the Effects on Muscle Mass
Bones aren’t the only part of the musculoskeletal system that suffers from disordered eating. Muscle health can also take a hit. Malnourishment can also lead someone to lose muscle mass . This can cause the heart to shrink, resulting in heart failure. This is one of the most common reasons that people die from anorexia .
Long Term Effects of Eating Disorders on the Musculoskeletal System
Osteoporosis is a lifelong condition. While there are things that people can do to take care of their bones, once the bone mass is gone it is impossible to reverse it without medical help. Even then, it may not be possible to fully recover all that was lost. This can leave someone at an increased risk of fracture, pain, and disability.
Healing bone loss requires someone to recover from their eating disorder. It’s impossible to maintain healthy bone density if someone does not have the appropriate amount of nutrition . National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2018). What People With Anorexia Nervosa Need to Know about Osteoporosis. Retrieved October 24th, 2021 from https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/anorexia-nervosa  Warren, M.P & Chua (2008). Exercise-induced amenorrhea and bone health in the adolescent athlete. New York Academy of Sciences, 1135, 244-255. Retrieved October 24th, 2021 from https://celebrationdayforgirls.com/wp-content/uploads/2015/05/Warren_et_al-2008-Annals_of_the_New_York_Academy_of_Sciences.pdf  O’Brien, Moira. (n.d). Osteoporosis in Athletes. Irish Osteoporosis Society. Retrieved October 24th, 2021 from https://www.irishosteoporosis.ie/information-support/who-is-at-risk/athletes/  Schoen Clinic Newbridge. (n.d). The Physical Effects of Anorexia. Retrieved October 24th, 2021 from https://www.schoen-clinic.co.uk/eating-disorders/help-and-support/the-physical-effects-of-anorexia
Author: Samantha Bothwell, LMFT
Page Last Reviewed & Approved By: Jacquelyn Ekern, MS, LPC 2.8.22