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Rosa-Caldwell ME, Eddy KT, Rutkove SB, Breithaupt L. Anorexia nervosa and muscle health: A systematic review of our current understanding and future recommendations for study. Int J Eat Disord 2023; 56:483-500. [PMID: 36529682 DOI: 10.1002/eat.23878] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Conduct a systematic review on muscle size and strength in individuals with anorexia nervosa (AN). METHOD In accordance with PRISMA guidelines, we searched Pubmed for articles published between 1995 and 2022 using a combination of search terms related to AN and muscle size, strength, or metabolism. After two authors screened articles and extracted data, 30 articles met inclusion criteria. Data were coded, and a risk bias was conducted for each study. RESULTS The majority of studies focused on muscle size/lean mass (60%, n = 18) and energy expenditure (33%, n = 9), with few studies (17%, n = 5) investigating muscle function or possible mechanisms underlying muscle size (20%, n = 6). Studies supported that individuals with AN have smaller muscle size and reduced energy expenditure relative to controls. In some studies (33%, n = 10) recovery from AN was not sufficient to restore muscle mass or function. Mechanisms underlying short and long-term musculoskeletal alterations have not been thoroughly explored. DISCUSSION Muscle mass and strength loss may be an unexplored component of physiological deterioration during and after AN. More research is necessary to understand intramuscular alterations during AN and interventions to facilitate muscle mass and functional gain following weight restoration in AN. PUBLIC SIGNIFICANCE Muscle health is important for optimal health and is reduced in individuals with AN. However, we do not understand how muscle is altered at the cellular level throughout the course of AN. Here we review what is currently known regarding muscle health during AN and with weight restoration.
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Affiliation(s)
- Megan E Rosa-Caldwell
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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2
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Solomon N, Sailer A, Dixe de Oliveira Santo I, Pillai A, Heng LXX, Jha P, Katz DS, Zulfiqar M, Sugi M, Revzin MV. Sequelae of Eating Disorders at Imaging. Radiographics 2022; 42:1377-1397. [PMID: 35930473 DOI: 10.1148/rg.220018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although eating disorders are common, they tend to be underdiagnosed and undertreated because social stigma tends to make patients less likely to seek medical attention and less compliant with medical treatment. Diagnosis is crucial because these disorders can affect any organ system and are associated with the highest mortality rate of any psychiatric disorder. Because of this, imaging findings, when recognized, can be vital to the diagnosis and management of eating disorders and their related complications. The authors familiarize the radiologist with the pathophysiology and sequelae of eating disorders and provide an overview of the related imaging findings. Some imaging findings associated with eating disorders are nonspecific, and others are subtle. The presence of these findings should alert the radiologist to correlate them with the patient's medical history and laboratory results and the clinical team's findings at the physical examination. The combination of these findings may suggest a diagnosis that might otherwise be missed. Topics addressed include (a) the pathophysiology of eating disorders, (b) the clinical presentation of patients with eating disorders and their medical complications and sequelae, (c) the imaging features associated with common and uncommon sequelae of eating disorders, (d) an overview of management and treatment of eating disorders, and (e) conditions that can mimic eating disorders (eg, substance abuse, medically induced eating disorders, and malnourishment in patients with cancer). Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Nadia Solomon
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Anne Sailer
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Irene Dixe de Oliveira Santo
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Aishwarya Pillai
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Lauren Xuan Xin Heng
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Priyanka Jha
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Douglas S Katz
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Maria Zulfiqar
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Mark Sugi
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Margarita V Revzin
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
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3
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Shalof H, Dimitri P, Shuweihdi F, Offiah AC. "Which skeletal imaging modality is best for assessing bone health in children and young adults compared to DXA? A systematic review and meta-analysis". Bone 2021; 150:116013. [PMID: 34029779 DOI: 10.1016/j.bone.2021.116013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/07/2021] [Accepted: 05/14/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Skeletal imaging techniques have become clinically valuable methods for measuring and assessing bone mineral density in children and young people. Dual-energy X-ray absorptiometry (DXA) is the current reference standard for evaluating bone density, as recommended by the International Society for Clinical Densitometry (ISCD). Various bone imaging modalities, such as quantitative ultrasound (QUS), peripheral quantitative computed tomography (pQCT), high-resolution peripheral quantitative computed tomography (HR-pQCT), magnetic resonance imaging (MRI), and digital X-ray radiogrammetry (DXR) have been developed to further quantify bone health in children and adults. The purpose of this review, with meta-analysis, was to systematically research the literature to compare the various imaging methods and identify the best modality for assessing bone status in healthy papulations and children and young people with chronic disease (up to 18 years). METHODS A systematic computerized search of Medline, PubMed, and Web of Science databases was conducted to identify English-only studies published between 1st January 1990 and 1st December 2019. In this review, clinical studies comparing imaging modalities with DXA were chosen according to the inclusion criteria. The risk of bias and quality of articles was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). The meta-analysis to estimate the overall correlation was performed using a Fisher Z transformation of the correlation coefficient. Additionally, the diagnostic accuracy measures of different imaging methods compared with DXA were calculated. RESULTS The initial search strategy identified 13,412 papers, 29 of which matched the inclusion and exclusion criteria. Of these, twenty-two papers were included in the meta-analysis. DXA was compared to QUS in 17 papers, to DXR in 7 and to pQCT in 4 papers. A single paper compared DXA, DXR, and pQCT. The meta-analysis demonstrated that the strongest correlation was between DXR and DXA, with a coefficient of 0.71 [95%CI: 0.43; 1.00, p-value < 0.001], while the correlation coefficients between QUS and DXA, and pQCT and DXA were 0.57 [95%CI: 0.25; 0.90, p-value < 0.001] and 0.57 [95%CI: 0.46; 0.67, p-value < 0.001], respectively. The overall sensitivity and specificity were statistically significant 0.71 and 0.80, respectively. CONCLUSION No current imaging modality provides a full evaluation of bone health in children and young adults, with each method having some limitations. Compared to QUS and pQCT, DXR achieved the strongest positive relationship with DXA. DXR should be further evaluated as a reliable method for assessing bone health and as a predictor of fractures in children and young people.
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Affiliation(s)
- Heba Shalof
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Western Bank, Sheffield S10 2TH, United Kingdom; Faculty of Medicine, Omar Al-Mukhtar University, Bayda, Libya.
| | - Paul Dimitri
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Western Bank, Sheffield S10 2TH, United Kingdom; Department of Pediatric Endocrinology, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, United Kingdom
| | - Farag Shuweihdi
- Leeds Institute of Health Sciences, School of medicine, University of Leeds, Leeds, United Kingdom
| | - Amaka C Offiah
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Western Bank, Sheffield S10 2TH, United Kingdom; Radiology Department, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, United Kingdom
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Valkama S, Holmlund-Suila E, Ireland A, Hauta-Alus H, Enlund-Cerullo M, Rosendahl J, Andersson S, Mäkitie O. Peripheral quantitative computed tomography (pQCT) in 12- and 24-month-old children - Practical aspects and descriptive data. Bone 2020; 141:115670. [PMID: 33007527 DOI: 10.1016/j.bone.2020.115670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/31/2020] [Accepted: 09/24/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Peripheral quantitative computed tomography (pQCT) is a useful tool to assess detailed bone characteristics. Its utility in infants is however limited due to lack of reference data and technical challenges. The purpose of this study was to provide data on length- and weight-adjusted pQCT values and to present a quality grading system for healthy children aged 12 and 24 months. MATERIAL AND METHODS As a part of the Vitamin D intervention in Infants (VIDI) trial, we collected pQCT and anthropometric data from 855 children at 12 months and from 784 children at 24 months. Bone mineral content (BMC; mg/mm), volumetric bone mineral density (vBMD; mg/cm3), cross-sectional area (CSA; mm2), polar-moment of inertia (PMI; mm4), and periosteal circumference (PsC; mm) were assessed for total bone at 20% distal site of the left tibia using pQCT (Stratec XCT2000L). We evaluated the impact of scan quality on bone measures. Total bone parameters were assessed for boys and girls separately. The means of the bone parameters were also compared in relation to age. The associations between bone parameters and weight, length, sex and scan quality were analyzed. RESULTS We included scans with sufficient quality (Grade 1-5) in the final analyses: 679/855 (79%) at 12 months and 709/784 (90%) at 24 months. Altogether 39% of the scans at 12 months and 51% at 24 months were of good or excellent quality (Grade 1-2). Scan quality had an impact on BMCs at 12 and 24 months (p = 0.001 and p = 0.017, respectively) but not on other bone parameters. Boys presented greater total bone BMC, CSA, PMI and PsC values at 12 and 24 months but vBMDs were similar. All bone parameters showed a significant increase between 12 and 24 months for both sexes. When adjusting bone parameters for weight, length and scan quality, differences between sexes disappeared. Weight was the strongest modifier of BMC, CSA, PMI and PsS at 12 and 24 months. CONCLUSIONS This study increases our understanding on bone parameters in young children and demonstrates the suitability of pQCT in bone research in infants. The described pQCT data and scan quality grading system should prove useful in evaluating data reliability in research settings. CLINICAL TRIAL REGISTRATION NUMBER NCT1723852.
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Affiliation(s)
- Saara Valkama
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Elisa Holmlund-Suila
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Alex Ireland
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Helena Hauta-Alus
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland
| | - Maria Enlund-Cerullo
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Jenni Rosendahl
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Sture Andersson
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Outi Mäkitie
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland; Department of Molecular Medicine and Surgery, Karolinska Institutet and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
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5
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Frølich J, Winkler LAD, Abrahamsen B, Bilenberg N, Hermann AP, Støving RK. Assessment of fracture risk in women with eating disorders: The utility of dual-energy x-ray absorptiometry (DXA)-Clinical cohort study. Int J Eat Disord 2020; 53:595-605. [PMID: 32048754 DOI: 10.1002/eat.23245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/13/2020] [Accepted: 01/22/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Eating disorders (EDs) are associated with decreased bone mineral density (BMD) and increased fracture risk. The association between BMD and fracture risk in EDs is not well elucidated. We aimed to assess BMD in an ED cohort of patients with active disease and patients in remission, and to assess the predictive value of BMD on incidence of fractures. METHOD We included 344 female patients (median age 19, IQR 16; 24) referred to ED treatment. Later, patients were invited to follow-up including assessment of remission status and a dual-energy x-ray absorptiometry (DXA)-scan. Information on fractures was obtained through the Danish National Registry of Patients. RESULTS Patients with current anorexia nervosa (AN) had significantly lower BMD compared to controls at lumbar spine (16% lower, p < .0001), femoral neck (18% lower, p < .0001), and total hip (23% lower, p < .0001). Recovered AN patients had higher BMD compared to those with current disease (p < .0001 for all measures), but lower BMD compared to controls at lumbar spine (p < .01) and hip (p < .001). BMD did not differ between BN patients and controls. In patients with active eating disorders not otherwise specified, BMD was lower only at the total hip (p < .005). We found no association between BMD and fracture risk. CONCLUSION We confirm that AN is associated with low BMD, whereas BN is not. Remission is associated with higher BMD compared to patients with active AN, but a deficit remains. We found no significant association between BMD and fracture risk, challenging the benefit of the widespread use of DXA scans in young women with ED. CLINICAL TRIAL REGISTRATION The study is registered in ClinicalTrials.gov, number NCT00267228.
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Affiliation(s)
- Jacob Frølich
- Centre for Eating Disorders, Odense University Hospital, Odense, Denmark.,Elite Research Center for Medical Endocrinology, Odense University Hospital, Odense, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Mental Health, Department of Child and Adolescence Psychiatry, Mental Health Service in the Region of Southern Denmark, Odense, Denmark
| | - Laura Al-Dakhiel Winkler
- Centre for Eating Disorders, Odense University Hospital, Odense, Denmark.,Mental Health, Department of Child and Adolescence Psychiatry, Mental Health Service in the Region of Southern Denmark, Odense, Denmark
| | - Bo Abrahamsen
- OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Medicine, Holbaek Hospital, Holbaek, Denmark.,Nuffield Department of Orthopaedics and Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Niels Bilenberg
- OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Mental Health, Department of Child and Adolescence Psychiatry, Mental Health Service in the Region of Southern Denmark, Odense, Denmark
| | - Anne P Hermann
- Elite Research Center for Medical Endocrinology, Odense University Hospital, Odense, Denmark
| | - René K Støving
- Centre for Eating Disorders, Odense University Hospital, Odense, Denmark.,Elite Research Center for Medical Endocrinology, Odense University Hospital, Odense, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Mental Health, Department of Child and Adolescence Psychiatry, Mental Health Service in the Region of Southern Denmark, Odense, Denmark
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Kralick AE, Zemel BS. Evolutionary Perspectives on the Developing Skeleton and Implications for Lifelong Health. Front Endocrinol (Lausanne) 2020; 11:99. [PMID: 32194504 PMCID: PMC7064470 DOI: 10.3389/fendo.2020.00099] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/17/2020] [Indexed: 12/17/2022] Open
Abstract
Osteoporosis is a significant cause of morbidity and mortality in contemporary populations. This common disease of aging results from a state of bone fragility that occurs with low bone mass and loss of bone quality. Osteoporosis is thought to have origins in childhood. During growth and development, there are rapid gains in bone dimensions, mass, and strength. Peak bone mass is attained in young adulthood, well after the cessation of linear growth, and is a major determinant of osteoporosis later in life. Here we discuss the evolutionary implications of osteoporosis as a disease with developmental origins that is shaped by the interaction among genes, behavior, health status, and the environment during the attainment of peak bone mass. Studies of contemporary populations show that growth, body composition, sexual maturation, physical activity, nutritional status, and dietary intake are determinants of childhood bone accretion, and provide context for interpreting bone strength and osteoporosis in skeletal populations. Studies of skeletal populations demonstrate the role of subsistence strategies, social context, and occupation in the development of skeletal strength. Comparisons of contemporary living populations and archeological skeletal populations suggest declines in bone density and strength that have been occurring since the Pleistocene. Aspects of western lifestyles carry implications for optimal peak bone mass attainment and lifelong skeletal health, from increased longevity to circumstances during development such as obesity and sedentism. In light of these considerations, osteoporosis is a disease of contemporary human evolution and evolutionary perspectives provide a key lens for interpreting the changing global patterns of osteoporosis in human health.
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Affiliation(s)
- Alexandra E. Kralick
- Department of Anthropology, University of Pennsylvania, Philadelphia, PA, United States
| | - Babette S. Zemel
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- *Correspondence: Babette S. Zemel
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7
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DiVasta AD, Feldman HA, O’Donnell JM, Long J, Leonard MB, Gordon CM. Impact of Adrenal Hormone Supplementation on Bone Geometry in Growing Teens With Anorexia Nervosa. J Adolesc Health 2019; 65:462-468. [PMID: 31227390 PMCID: PMC7001735 DOI: 10.1016/j.jadohealth.2019.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Adolescents with anorexia nervosa (AN) have decreased dehydroepiandrosterone (DHEA) and estrogen concentrations that may contribute to skeletal deficits. We sought to determine whether DHEA + estrogen replacement (ERT) prevented bone loss in young adolescents with AN. METHODS We recruited females with AN (n = 70, ages 11-18 years) into a 12-month, randomized, double-blind placebo-controlled trial. Participants were randomized to oral micronized DHEA 50 mg + 20 mcg ethinyl estradiol/.1 mg levonorgestrel daily (n = 35) or placebo (n = 35). Outcomes included serial measures of bone mineral density (BMD) by dual-energy X-ray absorptiometry (total body, hip, spine) and peripheral quantitative computed tomography (pQCT; tibia). Magnetic resonance imaging of T1-weighted images of the left knee determined physeal status (open/closed). RESULTS Sixty-two subjects completed the trial. Physeal closure status was the strongest predictor of aBMD changes. Among girls with open physes, those who received DHEA + ERT showed a decline in BMD Z-scores compared with those receiving placebo, whereas there was no effect in those with at least one closed physis. Treatment did not affect any pQCT measures, regardless of physeal closure status. CONCLUSIONS Combined DHEA + ERT did not significantly improve dual-energy X-ray absorptiometry or pQCT BMD measurements in young adolescent girls with AN, in contrast to an earlier trial showing benefit in older adolescents and young women. In girls with open physes, the mean change in the placebo arm was greater than that of the DHEA + ERT group. We conclude that DHEA + ERT is ineffective for preserving bone health in growing young adolescents with AN at the dose and route of administration described in this report.
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Affiliation(s)
- Amy D. DiVasta
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA,Division of Gynecology, Boston Children’s Hospital, Boston, MA, USA
| | - Henry A. Feldman
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, USA,Division of Endocrinology, Boston Children’s Hospital, Boston, MA, USA
| | | | - Jin Long
- Division of Pediatric Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Mary B. Leonard
- Division of Pediatric Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Catherine M. Gordon
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
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8
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Singhal V, Sanchita S, Malhotra S, Bose A, Flores LPT, Valera R, Stanford FC, Slattery M, Rosenblum J, Goldstein MA, Schorr M, Ackerman KE, Miller KK, Klibanski A, Bredella MA, Misra M. Suboptimal bone microarchitecure in adolescent girls with obesity compared to normal-weight controls and girls with anorexia nervosa. Bone 2019; 122:246-253. [PMID: 30853658 PMCID: PMC6636859 DOI: 10.1016/j.bone.2019.03.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite their higher areal bone mineral density (aBMD), adolescents with obesity (OB) have an increase in fracture risk, particularly of the extremities, compared with normal-weight controls. Whereas bone parameters that increase fracture risk are well characterized in anorexia nervosa (AN), the other end of nutritional spectrum, these data are lacking in adolescents with obesity. OBJECTIVE Our objective was to compare bone parameters in adolescent girls across the nutritional spectrum, to determine whether suboptimal bone adaptation to increased body weight may explain the increased fracture risk in OB. METHODS We assessed bone endpoints in 153 adolescent girls 14-21 years old: 50 OB, 48 controls and 55 AN. We used (i) DXA to assess aBMD at the lumbar spine, proximal femur and whole body, and body composition, (ii) high resolution peripheral quantitative CT (HRpQCT) to assess bone geometry, microarchitecture and volumetric BMD (vBMD), and (iii) finite element analysis to assess failure load (a strength estimate) at the distal radius and tibia. All aBMD, microarchitecture and FEA analyses were controlled for age and race. RESULTS Groups did not differ for age or height. Areal BMD Z-scores at all sites were highest in OB, intermediate in controls and lowest in AN (p < 0.0001). At the radius, cortical area and thickness were higher in OB compared to AN and control groups (p = 0.001) while trabecular area did not differ across groups. Compared to controls, OB had higher cortical porosity (p = 0.003), higher trabecular thickness (p = 0.024), and higher total, cortical and trabecular vBMD and rod BV/TV (p < 0.04). Plate BV/TV did not differ in OB vs. controls, but was higher than in AN (p = 0.001). At the tibia, total, cortical, and trabecular area and cortical thickness were higher in OB vs. controls and AN (p < 0.005). OB also had higher cortical porosity (p < 0.007) and lower trabecular thickness (p < 0.02) than the other two groups. Trabecular number, total and trabecular vBMD, and rod BV/TV were higher in OB vs. controls and AN (p < 0.02), while cortical vBMD and plate BV/TV did not differ in OB vs. the other two groups. Finally, failure load (a strength estimate) was higher in OB at the radius and tibia compared to controls and AN (p < 0.004 for all). However, after adjusting for body weight, failure load was lower in OB vs. controls at both sites (p < 0.05), and lower than in AN at the distal tibia. CONCLUSION Not all bone parameters demonstrate appropriate adaptation to higher body weight. Cortical porosity and plate BV/TV at the radius and tibia, and cortical vBMD and trabecular thickness at the tibia are particularly at risk. These effects may contribute to the higher risk for fracture reported in OB vs. controls.
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Affiliation(s)
- Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, United States of America; Division of Pediatric Endocrinology, Massachusetts General Hospital for Children, Harvard Medical School, United States of America; MGH Weight Center, United States of America.
| | - Smriti Sanchita
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, United States of America
| | - Sonali Malhotra
- Division of Pediatric Endocrinology, Massachusetts General Hospital for Children, Harvard Medical School, United States of America
| | - Amita Bose
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, United States of America
| | - Landy Paola Torre Flores
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, United States of America
| | - Ruben Valera
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, United States of America
| | - Fatima Cody Stanford
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, United States of America; MGH Weight Center, United States of America
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, United States of America
| | - Jennifer Rosenblum
- Division of Adolescent Medicine, Massachusetts General Hospital for Children, Harvard Medical School, United States of America
| | - Mark A Goldstein
- Division of Adolescent Medicine, Massachusetts General Hospital for Children, Harvard Medical School, United States of America
| | - Melanie Schorr
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, United States of America
| | - Kathryn E Ackerman
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, United States of America; Divison of Sports Medicine, Boston Children's Hospital, Harvard Medical School, United States of America
| | - Karen K Miller
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, United States of America
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, United States of America
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, United States of America
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, United States of America; Division of Pediatric Endocrinology, Massachusetts General Hospital for Children, Harvard Medical School, United States of America
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9
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Schorr M, Klibanski A. Anorexia Nervosa and Bone. CURRENT OPINION IN ENDOCRINE AND METABOLIC RESEARCH 2018; 3:74-82. [PMID: 31803857 PMCID: PMC6892594 DOI: 10.1016/j.coemr.2018.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Anorexia nervosa (AN), a psychiatric disorder characterized by altered body image, food restriction and low body weight, is associated with low bone mineral density and increased fracture risk. Despite broadening the definition of AN in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, the prevalence of low bone mass remains high, suggesting we continue to capture individuals at high risk for bone loss. Many of the endocrine disturbances adaptive to the state of chronic starvation are thought to be causal in impaired skeletal integrity in females and males with AN. Understanding mechanisms responsible for impaired bone quality is important given the disease's severity and chronicity. Further research is needed to formulate optimal treatment strategies to reduce fracture risk.
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Affiliation(s)
- Melanie Schorr
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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10
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Chou SH, Mantzoros C. Bone metabolism in anorexia nervosa and hypothalamic amenorrhea. Metabolism 2018; 80:91-104. [PMID: 29107598 DOI: 10.1016/j.metabol.2017.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 01/09/2023]
Abstract
Anorexia nervosa (AN) and hypothalamic amenorrhea (HA) are states of chronic energy deprivation associated with severely compromised bone health. Poor bone accrual during adolescence followed by increased bone loss results in lifelong low bone density, degraded bone architecture, and higher risk of fractures, despite recovery from AN/HA. Amenorrhea is only one of several compensatory responses to the negative energy balance. Other hypothalamic-pituitary hormones are affected and contribute to bone deficits, including activation of hypothalamic-pituitary-adrenal axis and growth hormone resistance. Adipokines, particularly leptin, provide information on fat/energy stores, and gut hormones play a role in the regulation of appetite and food intake. Alterations in all these hormones influence bone metabolism. Restricted in scope, current pharmacologic approaches to improve bone health have had overall limited success.
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Affiliation(s)
- Sharon H Chou
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Christos Mantzoros
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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11
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Singhal V, Tulsiani S, Campoverde KJ, Mitchell DM, Slattery M, Schorr M, Miller KK, Bredella MA, Misra M, Klibanski A. Impaired bone strength estimates at the distal tibia and its determinants in adolescents with anorexia nervosa. Bone 2018; 106:61-68. [PMID: 28694162 PMCID: PMC5694353 DOI: 10.1016/j.bone.2017.07.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/29/2017] [Accepted: 07/06/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Altered bone microarchitecture and higher marrow adipose tissue (MAT) may reduce bone strength. High resolution pQCT (HRpQCT) allows assessment of volumetric BMD (vBMD), and size and microarchitecture parameters of bone, while 1H-magnetic resonance spectroscopy (1H-MRS) allows MAT evaluation. We have reported impaired microarchitecture at the non-weight bearing radius in adolescents with anorexia nervosa (AN) and that these changes may precede aBMD deficits. Data are lacking regarding effects of AN on microarchitecture and strength at the weight-bearing tibia in adolescents and young adults, and the impact of changes in microarchitecture and MAT on strength estimates. OBJECTIVE To compare strength estimates at the distal tibia in adolescents/young adults with AN and controls in relation to vBMD, bone size and microarchitecture, and spine MAT. DESIGN AND METHODS This was a cross-sectional study of 47 adolescents/young adults with AN and 55 controls 14-24years old that assessed aBMD and body composition using DXA, and distal tibia vBMD, size, microarchitecture and strength estimates using HRpQCT, extended cortical analysis, individual trabecular segmentation, and finite element analysis. Lumbar spine MAT (1H-MRS) was assessed in a subset of 19 AN and 22 controls. RESULTS Areal BMD Z-scores were lower in AN than controls. At the tibia, AN had greater cortical porosity, lower total and cortical vBMD, cortical area and thickness, trabecular number, and strength estimates than controls. Within AN, strength estimates were positively associated with lean mass, aBMD, vBMD, bone size and microarchitectural parameters. MAT was higher in AN, and associated inversely with strength estimates. CONCLUSIONS Adolescents/young adults with AN have impaired microarchitecture at the weight-bearing tibia and higher spine MAT, associated with reduced bone strength.
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Affiliation(s)
- Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States; Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States.
| | - Shreya Tulsiani
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Karen Joanie Campoverde
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Deborah M Mitchell
- Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Melanie Schorr
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Karen K Miller
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States; Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
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12
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Abstract
PURPOSE OF REVIEW Eating Disorders are psychiatric disorders associated with a high risk for low bone mineral density (BMD) and fractures. Low BMD is a consequence of undernutrition, changes in body composition, and hormonal alterations. This review summarizes recent findings regarding novel strategies for assessing bone outcomes in patients with eating disorders, factors contributing to altered bone metabolism, and possible therapeutic strategies. RECENT FINDINGS Emerging research in this field suggests that not only anorexia nervosa, but also bulimia nervosa results in lower BMD compared to controls. To date studies of bone structure, and all randomized controlled trials examining the impact of various therapies on bone outcomes in anorexia nervosa, have focused on adolescent girls and women. We discuss the impact of anorexia nervosa on bone structure, and associations of resting energy expenditure, marrow adipose tissue (including the ratio of saturated to unsaturated fat), and cold activated brown adipose tissue with BMD and bone structure. Promising strategies for treatment include physiological estrogen replacement (rather than oral contraceptives) in adolescent girls with anorexia nervosa, and bisphosphonates, as well as teriparatide, in adult women with anorexia nervosa. SUMMARY Recent data on (i) BMD and bone structure in adolescent girls and women with eating disorders, (ii) factors that contribute to altered bone metabolism, and (iii) randomized controlled trials reporting positive effects of physiologic estrogen replacement, bisphosphonates and teriparatide on bone health, provide us with a greater understanding of the impact of eating disorders on bone and novel management strategies.
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Affiliation(s)
- Lauren Robinson
- Institute of Child Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Nadia Micali
- Institute of Child Health, University College London, Gower Street, London, WC1E 6BT, UK
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Madhusmita Misra
- Pediatric Endocrine and Neuroendocrine Units, Massachusetts General Hospital, Boston, MA 02114, USA
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13
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Abstract
PURPOSE OF REVIEW Osteoporosis is an under-recognized complication of chronic illness in childhood. This review will summarize recent literature addressing the risk factors, evaluation, and treatment for early bone fragility. RECENT FINDINGS Criteria for the diagnosis of pediatric osteoporosis include the presence of low trauma vertebral fractures alone or the combination of low bone mineral density and several long bone fractures. Monitoring for bone health may include screening for vertebral fractures that are common but often asymptomatic. Pharmacologic agents should be offered to those with fragility fractures especially when spontaneous recovery is unlikely. Controversies persist about the optimal bisphosphonate agent, dose, and duration. Newer osteoporosis drugs have not yet been adequately tested in pediatrics, though clinical trials are underway. The prevalence of osteoporosis is increased in children with chronic illness. To reduce the frequency of fragility fractures requires increased attention to risk factors, early intervention, and additional research to optimize therapy and potentially prevent their occurrence.
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Affiliation(s)
- Monica Grover
- Department of Pediatrics, Division of Endocrinology, School of Medicine, Stanford University, Room H314, Stanford, CA, 94305, USA
| | - Laura K Bachrach
- Department of Pediatrics, Division of Endocrinology, School of Medicine, Stanford University, Room H314, Stanford, CA, 94305, USA.
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14
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DiVasta AD, Feldman HA, Rubin CT, Gallagher JS, Stokes N, Kiel DP, Snyder BD, Gordon CM. The ability of low-magnitude mechanical signals to normalize bone turnover in adolescents hospitalized for anorexia nervosa. Osteoporos Int 2017; 28:1255-1263. [PMID: 27909781 PMCID: PMC9769086 DOI: 10.1007/s00198-016-3851-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 11/21/2016] [Indexed: 12/24/2022]
Abstract
UNLABELLED We sought to determine whether low-magnitude mechanical stimulation (LMMS) normalizes bone turnover among adolescents hospitalized for anorexia nervosa (AN). Brief, daily LMMS prevents the decline in bone turnover typically seen during bed rest in AN. LMMS may have application for patients with AN in the inpatient setting to protect bone health. INTRODUCTION Malnourished adolescents with AN requiring medical hospitalization are at high risk for rapid reduction in skeletal quality. Even short-term bed rest can suppress normal patterns of bone turnover. We sought to determine whether LMMS normalizes bone turnover among adolescents hospitalized for complications of AN. METHODS In this randomized, double-blind trial, we prospectively enrolled adolescent females (n = 41) with AN, age 16.3 ± 1.9 years (mean ± SD) and BMI 15.6 ± 1.7 kg/m2. Participants were randomized to stand on a platform delivering LMMS (0.3 g at 32-37 Hz) or placebo platform for 10 min/day for 5 days. Serum markers of bone formation [bone-specific alkaline phosphatase (BSAP)], turnover [osteocalcin (OC)], and bone resorption [serum C-telopeptides (CTx)] were measured. From a random coefficients model, we constructed estimates and confidence intervals for all outcomes. RESULTS BSAP decreased by 2.8% per day in the placebo arm (p = 0.03) but remained stable in the LMMS group (p = 0.51, pdiff = 0.04). CTx did not change with placebo (p = 0.56) but increased in the LMMS arm (+6.2% per day, p = 0.04; pdiff = 0.01). Serum OC did not change in either group (p > 0.70). CONCLUSIONS Bed rest during hospitalization for patients with AN is associated with a suppression of bone turnover, which may contribute to diminished bone quality. Brief, daily LMMS prevents a decline in bone turnover during bed rest in AN. Protocols prescribing strict bed rest may not be appropriate for protecting bone health for these patients. LMMS may have application for these patients in the inpatient setting.
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Affiliation(s)
- A D DiVasta
- Division of Adolescent Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
- Division of Gynecology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
| | - H A Feldman
- Clinical Research Program, Boston Children's Hospital, Boston, MA, USA
| | - C T Rubin
- Department of Biomedical Engineering, State University of New York Stony Brook, Stony Brook, NY, USA
| | - J S Gallagher
- Division of Adolescent Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - N Stokes
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - D P Kiel
- Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - B D Snyder
- Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - C M Gordon
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
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15
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DiVasta AD, Feldman HA, O’Donnell JM, Long J, Leonard MB, Gordon CM. Effect of Exercise and Antidepressants on Skeletal Outcomes in Adolescent Girls With Anorexia Nervosa. J Adolesc Health 2017; 60:229-232. [PMID: 27939877 PMCID: PMC5267944 DOI: 10.1016/j.jadohealth.2016.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE We examined the relationships between malnutrition, lifestyle factors, and bone health in anorexia nervosa (AN) via dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT). METHODS Seventy adolescent girls with AN and 132 normal-weighted controls underwent pQCT tibial measures including trabecular volumetric bone mineral density (vBMD), cortical vBMD, and cortical thickness. Participants with AN underwent DXA measures of the axial skeleton. We assessed the association of DXA and pQCT measures with clinical and lifestyle variables. RESULTS Body mass index Z-score and ideal body weight percentage were positively correlated with trabecular vBMD, cortical CSA, and section modulus (p < .04). Exercise was associated with all pQCT measures but only with hip BMD by DXA. In AN, the use of antidepressants was associated with lower pQCT measures (p < .03). CONCLUSIONS Antidepressants may negatively, and exercise positively, influence BMD in adolescents with eating disorders. These findings offer a provocative look at two longstanding questions.
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Affiliation(s)
- Amy D. DiVasta
- Division of Adolescent Medicine, Boston Children’s Hospital and Harvard Medical School,Division of Gynecology, Boston Children’s Hospital and Harvard Medical School
| | - Henry A. Feldman
- Clinical Research Program, Boston Children’s Hospital,Division of Endocrinology, Boston Children’s Hospital
| | | | - Jin Long
- Division of Pediatric Nephrology, Stanford University School of Medicine
| | - Mary B. Leonard
- Division of Pediatric Nephrology, Stanford University School of Medicine
| | - Catherine M. Gordon
- Division of Adolescent and Transition Medicine, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine
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