Because estrogen deficiency predisposes to osteoporosis, we assessed the skeletal mass of women with anorexia nervosa, using direct photon absorptiometry to measure radial bone density in 18 anorectic women and 28 normal controls. The patients with anorexia had significantly reduced mean bone density as compared with the controls (0.64 +/- 0.06 vs. 0.72 +/- 0.04 g per square centimeter, P less than 0.001). Vertebral compression fractures developed in two patients, and bone biopsy in one of them demonstrated osteoporosis. Bone density in the patients was not related to the estradiol level (r = 0.02). Levels of parathyroid hormone, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D were normal despite low calcium intakes. The patients with anorexia who reported a high physical activity level had a greater bone density than the patients who were less active (P less than 0.001); this difference could not be accounted for by differences in age, relative weight, duration of illness, or serum estradiol levels. The bone density of physically active patients did not differ from that of active or sedentary controls. We conclude that women with anorexia nervosa have a reduced bone mass due to osteoporosis, but that a high level of physical activity may protect their skeletons.
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[Abstract][Full Text]
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(2001). Sex Steroids and Bone. Physiol. Rev.
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[Abstract][Full Text]
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(2000). Prevalence and Predictive Factors for Regional Osteopenia in Women with Anorexia Nervosa. ANN INTERN MED
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[Full Text]
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340: 1092-1098
[Full Text]
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(1997). Augmentation of Bone Mineral Density in Hirsute Women. J. Clin. Endocrinol. Metab.
82: 2821-2825
[Abstract][Full Text]
Clark, K., Allan, J. D., Perry, P. A., Ciliska, D., Hall, J. M.
(1997). Disordered Eating Behaviors and Bone-Mineral Density in Women Who Misuse Alcohol. West J Nurs Res
19: 32-55
[Abstract]
Ross, P. D.
(1996). Osteoporosis: Frequency, Consequences, and Risk Factors. Arch Intern Med
156: 1399-1411
[Abstract]
Finkelstein, J. S., Klibanski, A., Schaefer, E. H., Hornstein, M. D., Schiff, I., Neer, R. M.
(1994). Parathyroid Hormone for the Prevention of Bone Loss Induced by Estrogen Deficiency. NEJM
331: 1618-1623
[Abstract][Full Text]
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(1993). Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients. JPEN J Parenter Enteral Nutr
17: 1SA-52SA
Kadel, N. J., Teitz, C. C., Kronmal, R. A.
(1992). Stress fractures in ballet dancers. Am J Sports Med
20: 445-449
[Abstract]
White, C. M., Hergenroeder, A. C., Klish, W. J.
(1992). Bone Mineral Density in 15- to 21-Year-Old Eumenorrheic and Amenorrheic Subjects. Arch Pediatr Adolesc Med
146: 31-35
[Abstract]
Myburgh, K. H., Hutchins, J., Fataar, A. B., Hough, S. F., Noakes, T. D.
(1990). Low Bone Density Is an Etiologic Factor for Stress Fractures in Athletes. ANN INTERN MED
113: 754-759
[Abstract]
Drinkwater, B. L., Bruemner, B., Chesnut, C. H. III
(1990). Menstrual History as a Determinant of Current Bone Density in Young Athletes. JAMA
263: 545-548
[Abstract]
Van Vort, W. B., Rubenstein, M., Rose, R. P.
(1990). Osteoporosis With Pathologic Hip Fractures in Major Depression. J Geriatr Psychiatry Neurol
3: 10-12
[Abstract]
Greenspan, S. L., Oppenheim, D. S., Klibanski, A.
(1989). Importance of Gonadal Steroids to Bone Mass in Men with Hyperprolactinemic Hypogonadism. ANN INTERN MED
110: 526-531
[Abstract]
Cook, S. D., Harding, A. F., Thomas, K. A., Morgan, E. L., Schnurpfeil, K. M., Haddad, R. J. JR
(1987). Trabecular bone density and menstrual function in women runners. Am J Sports Med
15: 503-507
[Abstract]
Drinkwater, B. L., Nilson, K., Ott, S., Chesnut, C. H. III
(1986). Bone Mineral Density After Resumption of Menses in Amenorrheic Athletes. JAMA
256: 380-382
[Abstract]
Rigotti, N. A., Neer, R. M., Jameson, L.
(1986). Osteopenia and Bone Fractures in a Man With Anorexia Nervosa and Hypogonadism. JAMA
256: 385-388
[Abstract]
Riggs, B. L., Eastell, R.
(1986). Exercise, Hypogonadism, and Osteopenia. JAMA
256: 392-393
[Abstract]
WALKER, E. S.
(1985). Bulimia and Gastric Cancer. ANN INTERN MED
103: 305-305
[Abstract]
HEATH, H. III
(1985). Athletic Women, Amenorrhea, and Skeletal Integrity. ANN INTERN MED
102: 258-260
[Abstract]
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