Dr. Herzog
and his colleagues in the Neuroendocrine Unit went on to conduct a prospective,
observational study on the effects of weight gain and menstrual recovery on
measures of bone mineral density. Sixty-seven girls between the ages of 12 and
18 participated; thirty-four of the girls had anorexia nervosa and 33 were
healthy controls. Dual energy x-ray absorptiometry (DXA) was used to measure
participants’ lumbar and whole-body bone density at baseline and at 6 and 12
months.
Weight gain was defined as a 10% increase
in body mass index and menstrual recovery as three menses or more in the previous
6 months. The 34 subjects with anorexia were characterized as AN recovered (AN-recovered)
if they had both weight gain and menstrual recovery (n=14) and as AN not
recovered (AN-not recovered) if they did not have both weight gain and
menstrual recovery (n=20). Median duration of recovery was 9 months.
The girls with anorexia had lower
spine bone mineral content for bone area and lower whole-body bone area for
height, compared with controls. Weight
gain and menstrual recovery in anorexia (AN-recovered) resulted in
stabilization of bone mineral density measures, whereas bone density continued
to decline in those with anorexia who did not gain weight and resume their menses
(AN-not recovered). AN-recovered also predicted greater increases in spine bone
mineral content for bone area and whole-body bone area, compared with AN-not recovered.
The data indicate that weight gain
and menstrual recovery are associated with a halting of deterioration in bone
measures, even in the short term. This raises the question of whether sustained
recovery would result in significant increases in bone density parameters. The
findings underscore the importance of optimizing weight gain in adolescents
with anorexia and highlight the beneficial effects of even short-term weight
increase with resumption of menses.
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