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Acta Psychiatr Scand. 2016 May;133(5):341-51. doi: 10.1111/acps.12556. Epub 2016 Jan 13.

Bone mineral density, osteoporosis, and fractures among people with eating disorders: a systematic review and meta-analysis.

Author information

1
Department of Neurosciences, University of Padova, Padova, Italy.
2
Department of Medicine, Geriatrics Section, University of Padova, Italy.
3
The Zucker Hillside Hospital, Department of Psychiatry, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA.
4
Feinstein Institute for Medical Research, Manhasset, NY, USA.
5
Department of Medicine, DIMED, University of Padova, Padova, Italy.
6
Department of Rehabilitation Sciences, Leuven - University of Leuven, Leuven, Belgium.
7
Z.org Leuven, KU Leuven - University of Leuven, Kortenberg, Belgium.
8
Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy.
9
Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.
10
Health Service and Population Research Department, Institute of Psychiatry King's College London, London, UK.

Abstract

OBJECTIVE:

To provide meta-analytical evidence of bone mineral density (BMD), fractures, and osteoporosis rates in eating disorders (ED) vs. healthy controls (HCs).

METHOD:

Three independent authors searched major electronic databases from inception till August 2015 for cross-sectional studies reporting BMD in people with ED (anorexia nervosa, (AN); bulimia nervosa, (BN); eating disorders not otherwise specified, (EDNOS)) vs. HCs. Standardized mean differences (SMDs) ±95% and confidence intervals (CIs) were calculated for BMD, and odds ratios (ORs) for osteopenia, osteoporosis, and fractures.

RESULTS:

Overall, 57 studies were eligible, including 21 607 participants (ED = 6485, HCs = 15 122). Compared to HC, AN subjects had significantly lower BMD values at lumbar spine (SMD = -1.51, 95% CI = -1.75, -1.27, studies = 42), total hip (SMD = -1.56, 95%CI = -1.84, -1.28, studies = 23), intertrochanteric region (SMD = -1.80, 95%CI = -2.46, -1.14, studies = 7), trochanteric region (SMD = -1.05, 95%CI = -1.44, -0.66, studies = 7), and femoral neck (SMD = -0.98, 95%CI = -1.12, -0.77, studies = 20). Reduced BMD was moderated by ED illness duration and amenorrhea (P < 0.05). AN was associated with an increased likelihood of osteoporosis (OR = 12.59, 95%CI = 3.30-47.9, P < 0.001, studies = 4) and fractures (OR = 1.84, 95% CI = 1.17-2.89, I(2) = 56, studies = 6). No difference in BMD was found between BN and EDNOS vs. HC.

CONCLUSION:

People with AN have reduced BMD, increased odds of osteoporosis and risk of fractures. Proactive monitoring and interventions are required to ameliorate bone loss in AN.

KEYWORDS:

anorexia nervosa; bone density; bulimia nervosa; eating disorders; fractures

PMID:
26763350
DOI:
10.1111/acps.12556
[Indexed for MEDLINE]

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