As the mental illness with the highest mortality rate, anorexia nervosa is very dangerous and can have lasting adverse effects on health. In addition to cardiac issues, gastrointestinal disturbances, problems with hair and skin, and loss of menses, anorexia can lead to significant bone loss (osteoporosis). There are several factors that contribute to the development of osteoporosis in people with anorexia. Learning about how this condition develops and how it can be managed is key to lasting bone health.
Risk Factors for Osteoporosis
Not everyone who develops osteoporosis has struggled with an eating disorder. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, risk factors include:
- Thin or small frame
- Family history
- Lack of physical activity
- Lack of calcium intake
Bone loss leads to lower bone density and therefore higher risk of fracture. Osteoporosis develops over time and often isn’t detected until a fracture occurs. While osteoporosis can be prevented by building strong bones early in life, it can be difficult or impossible to reverse the longer the condition lasts.
A Frightening Consequence of Anorexia
The physical effects of anorexia have a strong impact on bone health. Low body weight leads to decreased estrogen in women, which in turn causes menstrual periods to cease (amenorrhea). Low estrogen negatively impacts bone health, as does increased amounts of the adrenal hormone cortisol. In male clients with anorexia, lower testosterone levels can also contribute to bone loss.
According to the Science of Eating Disorders, osteoporosis can develop quickly in clients with anorexia. One study of women with chronic anorexia determined that 75% had bone density in the femur that fell below the critical fracture threshold. The longer a person remains underweight and undernourished, the faster the bone loss occurs. This also results in osteoporosis that is difficult to reverse or manage.
The primary medical treatments for anorexia are also essential to encourage the return of normal bone health.
- Nutrition: Work with a dietitian to manage weight restoration and include calcium and vitamin D
- Exercise: In clients with anorexia, exercise may not be indicated until ideal body weight is reached. Even then, caution has to be given to exercise and attention paid to the patient’s tendency toward compulsive exercising.
- Overall healthy lifestyle: Smoking and alcohol consumption can contribute to bone loss.
- Medications: There are medications available to treat osteoporosis, although there is no cure. Some research suggests that estrogen replacement therapy can be of benefit.
- Regular bone density tests: People with anorexia should have bone density tests to determine levels of bone loss and risk of fracture.
National Institute of Arthritis and Musculoskeletal and Skin Diseases (2015). What People with Anorexia Nervosa Need to Know About Osteoporosis.