Searchable abstracts of presentations at key conferences on calcified tissues
Bone Abstracts (2015) 4 P170 | DOI: 10.1530/boneabs.4.P170

ICCBH2015 Poster Presentations (1) (201 abstracts)

Reduced spinal volumetric trabecular bone mineral density in adolescent girls with anorexia nervosa

Sarah Ehtisham 1 , Jane Whittaker 2 , Judith Adams 3 & Zulf Mughal 1

1Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, UK; 2Child and Adolescent Mental Health Services, Galaxy House, Royal Manchester Children’s Hospital, Manchester, UK; 3Department of Clinical Radiology, Manchester Royal Infirmary, Manchester, UK.

Background: Anorexia nervosa (AN) presenting in childhood can have devastating implications for growth, puberty, menstruation and bone health. It may lead to altered bone structure and inadequate acquisition of bone mass with increased risk of fracture.

Objective: To describe growth, pubertal and bone mineral density data in a cohort of adolescents with AN managed in a tertiary metabolic bone service.

Methods: 62 adolescent females with AN assessed between 2009 and 2014 underwent assessment of pubertal status, menstrual history, auxology and bone mineral density measured by DXA, QCT and pQCT. Size adjusted lumbar spine BMD (LS BMAD), LS volumetric (v) trabecular BMD (LS vTBMD), femoral neck BMD (FN BMAD), distal radial total & trabecular vBMD were measured at initial assessment.

Results: At presentation, the mean age was 16 years (1.45 S.D.). Seven had prepubertal onset of AN, 14 pubertal and 41 postpubertal. 25 were inpatient, 32% had back pain and one had experienced a metatarsal fracture from repetitive exercising. 42 presented with secondary amenorrhoea (mean duration 20 months, range 5–60). Mean BMISDS was −1.48 (−5.61–1.26). Baseline bone density z-scores are given in the table 1:

LS BMAD z-score was ≤−2.00 (−2.00 to −2.90) in 13 patients, whereas LS vTBMD z-score ≤−2.00 (−2.04 to −4.18) in 29 patients. One had mild grade 1 vertebral endplate fractures of T4, T5 and T7 on DXA vertebral fracture assessment. LS vTBMD was correlated with oestradiol concentrations and was significantly lower in those with oestradiol <120 pmol/l (−2.18 vs −1.70, P<0.05).

Table 1
LS BMADLS vTBMDFN BMADDistal radial total vBMDDistal radial trabecular vBMD
z-score (S.D.)−1.00 (0.96)−2.01 (0.95)−0.70 (0.98)0.07 (1.25)−0.09 (1.12)

Conclusion: Adolescent girls with AN have reduced size adjusted BMD for age at the lumbar spine. The marked decline in LS vTBMD, possibly due to relative hypercortisolaemia (Misra, Lancet Diabetes Endocrinology 2014) may increase the risk of sustaining atraumatic vertebral fractures.

Disclosure: The authors declared no competing interests.

Volume 4

7th International Conference on Children's Bone Health

Salzburg, Austria
27 Jun 2015 - 30 Jun 2015


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