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Int J Endocrinol. 2015;2015:628740. doi: 10.1155/2015/628740. Epub 2015 Feb 24.

Evidence for the adverse effect of starvation on bone quality: a review of the literature.

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  • 1Charit√© University of Medicine, Charit√©platz 1, 10117 Berlin, Germany.
  • 2Department of Orthopedic Surgery, Spine Surgery, Hadassah Medical Center, Kiryat Hadassah, P.O. Box 12000, 91120 Jerusalem, Israel.


Malnutrition and starvation's possible adverse impacts on bone health and bone quality first came into the spotlight after the horrors of the Holocaust and the ghettos of World War II. Famine and food restrictions led to a mean caloric intake of 200-800 calories a day in the ghettos and concentration camps, resulting in catabolysis and starvation of the inhabitants and prisoners. Severely increased risks of fracture, poor bone mineral density, and decreased cortical strength were noted in several case series and descriptive reports addressing the medical issues of these individuals. A severe effect of severely diminished food intake and frequently concomitant calcium- and Vitamin D deficiencies was subsequently proven in both animal models and the most common cause of starvation in developed countries is anorexia nervosa. This review attempts to summarize the literature available on the impact of the metabolic response to Starvation on overall bone health and bone quality.

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