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Bone turnover during inpatient nutritional therapy and outpatient follow-up in patients with anorexia nervosa compared with that in healthy control subjects^1,2,3,4

¹ From the DLR-Institute of Aerospace Medicine, Space Physiology, Cologne, Germany (MH and CM); the Institute of Aerospace Medicine (CM) and the Department of Child and Adolescent Psychiatry (IG and BH-D), Technical University of Aachen, Aachen, Germany; the Elisabeth-Clinic of Child and Adolescent Psychiatry, Dortmund, Germany (IG); and the Institute of Medical Statistics of the Medical Faculty of the RWTH, Aachen, Germany (NH)

Background: Osteopenia and osteoporosis are among the most frequent and severe complications in adolescents with anorexia nervosa.

Objective: The aim of this study was to assess the influence of nutritional therapy on bone metabolism during adolescent anorexia nervosa.

Design: We studied 19 anorectic patients aged 14.1 ± 1.4 y ( ± SD) with a body mass index (BMI; in kg/m²) of 14.2 ± 1.4 and 19 age-matched control subjects aged 15.1 ± 2.3 y with a BMI of 20.8 ± 1.9 for 1 y. Blood samples were taken for the measurement of bone markers, insulin-like growth factor I (IGF-I), and leptin.

Results: BMI rose significantly from 14.2 ± 1.4 at baseline to 17.4 ± 0.6 (P < 0.0001) at week 15. Compared with concentrations in the control subjects, concentrations of the bone formation markers procollagen type I propeptide (PICP) and bone alkaline phosphatase (bAP) in the anorectic patients were lower at baseline (PICP: P = 0.0071; bAP: P = 0.0012), increased with nutritional therapy (PICP: P = 0.0060, bAP: P = 0.0147), and were no longer significantly different (P > 0.05) during the follow-up period. Concentrations of IGF-I and leptin were significantly lower (P < 0.0001 for both) in the anorectic patients than in the control subjects at baseline. IGF-I increased with nutritional therapy but was still significantly lower (P = 0.0036) than that in the control group and decreased again during the follow-up period (P = 0.0126). In contrast, serum C-telopeptide decreased with nutritional therapy (P = 0.0446).

Conclusion: Nutritional therapy improves concentrations of bone formation markers in adolescent patients with anorexia nervosa.

Key Words: Adolescence • anorexia nervosa • nutritional therapy • weight gain • leptin • insulin-like growth factor I • IGF-I • bone turnover markers

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