Eating Disorders And Permanent Loss Of Bone Mass: Osteopenia, Osteoporosis, And Dowager’s Hump

Osteopenia, an unusual loss of mineral density in the bone, osteoporosis, a condition of significant loss of mineral density causing weak bones, and dowager's hump, a condition in which the bone of the cervical spine is too weak to carry the head upright, are relatively common in women who have anorexia. 

Just how severe is bone loss for women and teenage girls who have anorexia? One study found that:

• 93 percent of adult women who have anorexia have enough bone mineral loss to be diagnosed with osteopenia, and 40 percent of adult women who have anorexia have osteoporosis. But it isn't just adult women who are affected.
• That same study found that 50 percent of teenage girls who have anorexia have lost enough bone mineral density to be diagnosed with osteopenia, and 30 percent of teenage girls who have anorexia have broken a bone.

The most important thing a girl or woman who has anorexia can do to protect her bones is to conquer her eating disorder. But what pharmacological help is there to help her recover healthy bones?

• Oral contraceptives do not protect women who currently have anorexia from bone mineral loss.
• Estrogen patches, however, protect against bone mineral loss in women who current have anorexia.
• A class of drugs known as biphosphonates usually aren't given to women who have not yet reached menopause. When they have been tried in teenage girls, they have increased strength of the hip bone but not the spine. These drugs are not usually recommended for long-term use because they increase the amount of calcium in bone but they do not stimulate the collagen production that is necessary to provide a framework for holding mineral crystals in place.
• Teriparatide, a form of synthetic parathyroid hormone marketed under the trade name Forteo, has been shown to increase bone mineral density in one older woman (52 years old) who had anorexia. However, doctors are hesitant to give the drug to younger women because it has been linked to bone cancer.
• Stress hormones interfere with the creation of new bone, and stress hormone levels are generally higher in women who have anorexia. Reducing stress may help the bones replace lost minerals.
• Weight gain that is enough that normal menstrual cycles return increases estrogen levels and protects against further bone mineral loss.

It isn't just anorexia in women that can result in osteopenia and osteoporosis. Bulimia can also cause loss of bone minerals, but the risk of osteopenia and osteoporosis in women who have bulimia is much less severe.

• Teenage girls and women who have bulimia may or may not have irregular periods. (Girls and women who have anorexia usually don't have regular periods.) They have greater estrogen production so they have less bone loss.
• Unlike women and girls who have anorexia, women and girls who have bulimia get a bone-protective benefit from exercise. People who have bulimia who purge with exercise almost never have osteopenia or osteoporosis.
• Girls and women who have bulimia have an increased risk of polycystic ovarian syndrome (PCOS). This is a condition that involves excess testosterone. Fat cells convert excess testosterone in these women into estrogen that protects bones. PCOS causes a number of problems, but it is associated with fewer fractures and healthier bones in these women.

Among the supplements any woman or girl who has an eating disorder should take every day are:

• Calcium. Any kind of calcium can be helpful, but it's important not to take more than 500 mg at a time. That's the maximum amount the body can absorb in one dose. Up to 1,500 mg of calcium per day can be helpful.
• Vitamin D. The bones need the sunshine vitamin to absorb calcium. At least 1,000 IU  per day and up to 10,000 IU per day may be helpful.
• Vitamin K₂. This is a vitamin that helps make sure calcium goes into bone and not into soft tissues or the linings of arteries It is found in egg yolks, cream, butter, and a fermented soybean food called natto. It is also available as a nutritional supplement. Take 45 mg per day.
• Magnesium. The body uses this mineral to regulate its use of calcium. Many people who take magnesium report a calming effect. The body needs about 400 mg a day, but taking more than 600 mg a day will have a laxative effect.