Effects of Anorexia Nervosa on Bone Mass in Adolescents
Effects of Anorexia Nervosa on Bone Mass in Adolescents
This study is to determine the effects of anorexia nervosa on bone mass and hormone levels in
 adolescents. Whether administration of estrogen, a normal hormone present during puberty, can
 help maintain bone development in girls with anorexia nervosa will be determined.
Adolescence is a critical time for bone mineral accretion as between 60-90% of peak bone mass
 is established during this period, and peak bone mass is a major determinant of bone density
 and osteoporosis risk during adulthood. Anorexia nervosa (AN) is the third most common
 chronic illness among adolescent girls, with a prevalence of 0.2-1.0%. Therefore, AN occurs
 at a time during which patients are the most vulnerable to disruption of bone mineral
 accretion. Osteopenia is a major co-morbid complication of AN in 50-75% of female adolescents
 and adult women with this eating disorder. Women with the onset of the disorder during
 adolescence have more severe osteopenia than women with onset during adulthood. Little is
 known about the pathogenesis of osteopenia in this adolescent population and there are no
 established therapies. Improved understanding of bone mineral metabolism and factors which
 predict recovery of bone mineral accretion are critical in the development of therapeutic
 strategies to preserve and maximize bone mass in girls with the onset of AN during
 adolescence. Estrogen is known to be a critical factor in the development of peak bone mass.
 Although AN is associated with profound estrogen deficiency, there are no controlled studies
 investigating the effects of estrogen administration in this population.

 This research proposal will address critical unanswered questions regarding bone
 abnormalities in adolescents with anorexia nervosa. Defining changes in bone formation with
 weight recuperation and hormonal variables would provide insight into the factors essential
 for bone mineral accretion during adolescence, as well as those that predict recovery.
 Determination of dose-dependent estrogen effects in this population will be key in targeting
 interventions during the time of active disease, with the long-term goal of preserving peak
 bone mass accretion in this vulnerable group of patients. Data obtained from women with
 post-menopausal osteoporosis or from women with AN cannot be extrapolated to adolescent
 patients who are in an active period of bone growth and mineralization as well as remodeling.
 Given the increasing prevalence of AN and its profound consequences on bone health, these
 studies will provide much needed data to enable treatment strategies for this severe
 co-morbid disease.
Inclusion Criteria:

 -  Females Only with Anorexia Nervosa and Amenorrhea 12-18 years

 -  Normal-weight girls 12-18 years with no past or present history of an eating disorder

 Exclusion Criteria:

 -  Diseases affecting bone metabolism (including untreated thyroid disease, premature
 ovarian failure, diabetes, cancer, pituitary, renal disease or bone fracture within
 the past six months)

 -  Use of prescription medications affecting bone metabolism within three months

 -  Suicidality

 -  Psychosis

 -  Substance abuse

 -  Hematocrit <30 %

 -  Potassium <3.0 mmol/L

 -  Glucose <50 mg/dl.