Bone Health in Adolescents with Eating Disorders

Abstract

Impaired bone health with increased bone fragility is a potentially irreversible complication of eating disorders. Onset of an eating disorder is usually during adolescence, the critical time when peak bone mass is accrued. Adolescents with eating disorders have reduced bone mineral accrual, as well as accelerated bone resorption. Treatment of low bone mineral density remains challenging. Weight gain with resumption of spontaneous menses is associated with increases in bone mineral density, but residual deficits persist. As weight restoration is often a slow process, therapeutic strategies are needed to preserve bone mineral density during eating disorder treatment. Oral estrogen-progestin agents do not increase bone mineral density in adolescents with eating disorders, but physiological doses of transdermal estrogen with cyclic progestin may benefit some patients. The bisphosphonates are effective in adults, but concern about their efficacy and safety in adolescents limits their use. The future role of anabolic agents, bisphosphonates, and other antiresorptive agents remains to be determined. Current recommendations include weight restoration with resumption of spontaneous menses, moderate weight-bearing exercise, optimal calcium and vitamin D intake, and treatment of vitamin D deficiency.