Bone health in adolescent girls with anorexia nervosa – a pilot study

Česká verzia

Authors: P. Kabíček ¹; J. Běhounek ²; K. Jaššová ³; K. Bořecká ⁴; M. Bayer ^5,1; M. Magner ^1,6
Authors place of work: Pediatrická klinika 1. LF UK a Thomayerovy nemocnice, Praha ¹; Klinika revmatologie a rehabilitace 3. LF UK a Thomayerovy nemocnice, Praha ²; Oddělení dětské psychiatrie, Thomayerova nemocnice, Praha ³; Oddělení klinické biochemie, Thomayerova nemocnice, Praha ⁴; Klinika dětí a dorostu 3. LF UK a Fakultní nemocnice Královské Vinohrady, Praha ⁵; Klinika pediatrie a dědičných poruch metabolismu 1. LF UK a VFN, Praha ⁶
Published in the journal: Čes-slov Pediat 2020; 75 (6): 332-336.
Category:

Summary

Objective: Anorexia nervosa (anorexia nervosa, AN) significantly affects the bone health. The aim of our study was to evaluate the parameters of bone metabolism in a group of Czech girls with AN.

Patients and methods: The group included 32 girls with AN. Bone Mineral Density (BMD) of the lumbar spine, hip area, hormonal profile (LH, estradiol), and bone turnover parameters (osteocalcin, P1NP, beta-CTx) were examined.

Results: The group included 32 girls with an average age of 15.2 years (range 11–17 years), the disease duration of 8.7 months (range 3–24 months), an average weight loss of 12 kg (2–36 kg). The mean Z-score in the lumbar spine was 0.08±1.40, in the hip 0.23±1.28, and the overall Z-score was 0.13±1.14. When comparing the group of girls with primary amenorrhea or girls with secondary amenorrhea lasting 0–5 months and the group of girls with amenorrhea lasting 6 months and longer, a statistically insignificant decrease in the lumbar spine, hip and combined BMD was observed. Laboratory examination of bone turnover showed a reduction in osteocalcin (81.8% <50 p., 12.5% <2.5 p.), P1NP (84.3% <50 p., 21.8% <2.5. p.), while beta-CTx (34,7% >97. p.) was increased, according to normal ranges for the given age. Both estradiol and LH levels were reduced (53.1% <18.4 pmol/l; and 50% <0.1 U/l, respectively). In girls with the lowest plasma estradiol concentrations (<18.4 pmol/l), statistically significantly lower absolute hip BMD values were found p=0.009.

Conclusion: The results of the study show that hormonal changes precede changes in bone metabolism, which may later manifest at the level of morphologically measurable.

Keywords:

anorexia nervosa – body mass index – adolescence – bone mineral density – osteokalcin – P1NP – osteoporosis – mental anorexia

Zdroje

1. Papežová H, et al. Spektrum poruch příjmu potravy – interdisciplinární přístup. Praha: Grada Publishing, 2010: 1–424.

2. Frølich J, Winkler LA, Abrahamsen B, et al. Assessment of fracture risk in women with eating disorders: The utility of dual-energy x-ray absorptiometry (DXA) – Clinical cohort study. Int J Eat Disord 2020 Apr; 53 (4): 595–605.

3. Alberts Z, Fewtrell M, Nicholls DE, et al. Bone mineral density in anorexia nervosa versus avoidant restrictive food intake disorder. Bone 2020 May; 134: 115307. doi: 10.1016/j.bone.2020.115307.

4. Nagata JM, Carlson JL, Golden NH, et al. Comparisons of bone density and body composition among adolescents with anorexia nervosa and atypical anorexia nervosa. Int J Eat Disord 2019 May; 52 (5): 591–596.

5. Shepherd S, Kyriakou A, Guftar Shaikh M, et al. Longitudinal changes in bone parameters in young girls with anorexia nervosa. Bone 2018 Nov; 116: 22–27.

6. Mumford J, Kohn M, Briody J, et al. Long-term outcomes of adolescent anorexia nervosa on bone. J Adolesc Health 2019 Mar; 64 (3): 305–310.

7. Miller KK, Grinspoon SK, Ciampa J, et al. Medical findings in outpatients with anorexioa nervosa. Arch Intern Med 2005; 165 (5): 561–566.

8. Fazeli PK. Low bone mineral density in anorexia nervosa: Treatments and challenges. Clin Rev Bone Miner Metab 2019 Jun; 17 (2): 65–76.

9. Frølich J, Winkler LA, Abrahamsen B, et al. Fractures in women with eating disorders-Incidence, predictive factors, and the impact of disease remission: Cohort study with background population controls. Int J Eat Disord Jan 10. doi: 10.1002/eat.23223.

10. Lenherr-Taube M, Trajcevski K, Sochett E, et al. Low PTH levels in adolescents with anorexia nervosa. Front Pediatr 2020; 8: 99.

11. Giollo A, Idolazzi L, Caimmi C, et al. Vitamin D levels strongly influence bone mineral density and bone turnover markers during weight gain in female patients with anorexia nervosa. Int J Eat Disord 2017 Sep; 50 (9): 1041–1049.

12. Fazeli PK. Low bone mineral density in anorexia nervosa: Treatments and challenges. Clin Rev Bone Miner Metab 2019 Jun; 17 (2): 65–76.

13. Legroux I, Cortet B. Factors influencing bone loss in anorexia nervosa: assessment and therapeutic options. RMD Open 2019 Nov; 5 (2): e001009.

14. Stokes FJ, Ivanov P, Bailey LM, Frazer WD. The effects of samplings procedures and storage conditions on short-term stability of blood-based biochemical markers of bone metabolism. Clin Chem 2011; 57 (1): 138–140.

15. Brown JP, Albert C, Nassar BA, et al. Bone turnover markers in the management of osteoporosis. Clin Biochem 2009; 42: 929–942.

16. Vasikaran S, Cooper C, Eastell R, et al. International Osteoporosis Foundation and International Federation of Clinical Chemistry and Laboratory Medicine position on bone marker standards in osteoporosis. Clin Chem Lab Med 2011; 49 (8): 1271–1274.

17. Wheater G, Elshahaly M, Tuck SP, et al. The clinical utility of bone marker measurements in osteoporosis. J Transl Med 2013 Aug 29; 11: 201. doi: 10.1186/1479-5876-11-201.

18. Qvist P, Christgau S, Pedersen BJ, et al. Cicadian variation in the serum concentration of C-terminal telopeptide of type I collagen (serum CTX): effects of gender, age, menopausal status, posture, daylight, serum cortisol, and fasting. Bone 2002; 31: 57–61.

19. Garnero P. The contribution of collagen crosslinks to none strength. Bonekey Rep 2012; 1: 182. dostupné z https://doi.org/10.1038/bonekey.2012.182.

20. Gordon CM, Leonard MB, Zemel BS. 2013 Pediatric Position Development Conference: executive summary and reflections. J Clin Densitom 2014; 17: 219–224.

21. Bayer M. Reference values of osteocalcin and procollagen type I N-propeptide plasma levels in a healthy Central European population aged 0–18 years. Osteoporos Int 2014; 25: 729–736.

22. De Melo VCP, Ferreira PRS, Ricardi LO, et al. Definition of reference ranges for β-isomerized carboxy-terminal telopeptide collagen type I for children and adolescents. J Pediatr Endocrinol Metab 2018 Jun 27; 31 (6): 637–640. doi: 10.1515/jpem-2018-0005.

23. Bayer M. Normální hodnoty některých ukazatelů kostního obratu u české dětské populace. Labor Aktuell 2015; 4: 7–9.

24. Legroux-Gérot I, Vignau J, D´Herbomez M, et al. Evaluation of bone loss and its mechanisms in anorexia nervosa. Calcif Tissue Int 2007; 81: 174–182.

25. Misra M, Miller KK, Almaza C, et al. Alterations in cortisol secretory dynamics in adolescent girls with anorexia nervosa and effects on bone metabolism. J Clin Endocrinol Metab 2004; 89 (10): 4972–4980.

26. Bahamonde M, Misra M. Potential applications for rhIGF-I: Bone disease and IGF-I. Growth Horm IGF Res 2020 Mar 23; 52: 101317. doi: 10.1016/j.ghir.2020.10131.

27. Fazeli PK, Klibanski A. Effects of anorexia nervosa on bone metabo-lism. Endocr Rev 2018; 39 (6): 859–910.