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Jayasena CN, Devine K, Barber K, Comninos AN, Conway GS, Crown A, Davies MC, Ewart A, Seal LJ, Smyth A, Turner HE, Webber L, Anderson RA, Quinton R. Society for endocrinology guideline for understanding, diagnosing and treating female hypogonadism. Clin Endocrinol (Oxf) 2024. [PMID: 39031660 DOI: 10.1111/cen.15097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/18/2024] [Accepted: 05/27/2024] [Indexed: 07/22/2024]
Abstract
Female hypogonadism (FH) is a relatively common endocrine disorder in women of premenopausal age, but there are significant uncertainties and wide variation in its management. Most current guidelines are monospecialty and only address premature ovarian insufficiency (POI); some allude to management in very brief and general terms, and most rely upon the extrapolation of evidence from the studies relating to physiological estrogen deficiency in postmenopausal women. The Society for Endocrinology commissioned new guidance to provide all care providers with a multidisciplinary perspective on managing patients with all forms of FH. It has been compiled using expertise from Endocrinology, Primary Care, Gynaecology and Reproductive Health practices, with contributions from expert patients and a patient support group, to help clinicians best manage FH resulting from both POI and hypothalamo-pituitary disorders, whether organic or functional.
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Affiliation(s)
- Channa N Jayasena
- Section of Investigative Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - Kerri Devine
- Department of Endocrinology, Diabetes & Metabolism, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
- Translational & Clinical Research Institute, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, UK
| | - Katie Barber
- Community Gynaecology (NHS), Principal Medical Limited, Bicester, Oxfordshire, UK
- Oxford Menopause Ltd, Ardington, Wantage, UK
| | - Alexander N Comninos
- Division of Diabetes, Endocrinology & Metabolism, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | - Gerard S Conway
- Reproductive Medicine Unit, University College London Hospitals, London, UK
| | - Anna Crown
- Department of Endocrinology, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Melanie C Davies
- Reproductive Medicine Unit, University College London Hospitals, London, UK
| | - Ann Ewart
- Kallman Syndrome and Congenital Hypogonadotropic Hypogonadism Support Group, Dallas, Texas, United States
| | - Leighton J Seal
- Department of Endocrinology, St George's Hospital Medical School, London, UK
| | - Arlene Smyth
- UK Turner Syndrome Support Society, Clydebank, UK
| | - Helen E Turner
- Department of Endocrinology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lisa Webber
- Department of Obstetrics & Gynaecology, Singapore General Hospital, Singapore
| | - Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Richard Quinton
- Section of Investigative Medicine, Hammersmith Hospital, Imperial College London, London, UK
- Department of Endocrinology, Diabetes & Metabolism, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
- Translational & Clinical Research Institute, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, UK
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Amorim T, Khiyami A, Latif T, Fazeli PK. Neuroendocrine adaptations to starvation. Psychoneuroendocrinology 2023; 157:106365. [PMID: 37573628 PMCID: PMC10543597 DOI: 10.1016/j.psyneuen.2023.106365] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
Famine and starvation have punctuated the evolutionary past of the human species. As such, we have developed hormonal responses to undernutrition that minimize energy expenditure on processes that are not critical for the survival of the individual, such as reproduction. In this review, we discuss neuroendocrine adaptations to starvation including hypogonadotropic hypogonadism, growth hormone resistance, hypercortisolemia, and the downregulation of the hypothalamic-pituitary-thyroid axis. We review the time-course of these adaptations by describing studies involving the short-term fasting of healthy individuals as well as studies describing the hormonal changes in states of chronic undernutrition, using individuals with anorexia nervosa as a model of chronic starvation. Lastly, we review representative clinical effects of chronic undernutrition.
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Affiliation(s)
- Tânia Amorim
- Neuroendocrinology Unit, Division of Endocrinology and Metabolism University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Center for Human Integrative Physiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Anamil Khiyami
- Neuroendocrinology Unit, Division of Endocrinology and Metabolism University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Tariq Latif
- Neuroendocrinology Unit, Division of Endocrinology and Metabolism University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Pouneh K Fazeli
- Neuroendocrinology Unit, Division of Endocrinology and Metabolism University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Center for Human Integrative Physiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
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Murray Hurtado M, Martín Rivada Á, Quintero Alemán C, Ruiz Alcántara MP, Ramallo Fariña Y. Body composition and nutritional status changes in adolescents with anorexia nervosa. An Pediatr (Barc) 2023; 99:162-169. [PMID: 37563070 DOI: 10.1016/j.anpede.2023.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/12/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Nutritional status assessment in anorexia nervosa (AN) includes the evaluation and monitoring of body composition throughout the treatment period. The gold standard for the study of body composition is dual-energy X-ray absorptiometry (DEXA), although electrical bioimpedance (BIA) is a more accessible, cheaper and faster method that does not involve exposure to radiation. MATERIAL AND METHODS We recruited 33 female adolescents with AN (age, 11.7-16.3 years) by consecutive sampling. We collected data on clinical, anthropometric and laboratory variables. Patients were assessed with BIA and DEXA at inclusion in the study and at the end of the study, with a mean duration of follow-up of 1 year, during the nutritional rehabilitation phase. RESULTS There was significant improvement in nutritional status, reflected by the body composition obtained by anthropometric measurements and BIA. The phase angle increased significantly during the follow-up. Greater weight loss was associated with the presence of secondary amenorrhoea and decreased bone mineral density in the spine. CONCLUSIONS Electrical BIA is a useful tool for assessment and monitoring of nutritional status in paediatric patients with AN. Dual-energy X-ray absorptiometry continues to be essential to assess bone mineral density. The role of hormones such as leptin remains to be elucidated.
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Affiliation(s)
- Mercedes Murray Hurtado
- Sección Nutrición y Errores Innatos del Metabolismo, Complejo Hospitalario Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain.
| | - Álvaro Martín Rivada
- Sección Nutrición y Errores Innatos del Metabolismo, Complejo Hospitalario Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | | | | | - Yolanda Ramallo Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Colegio Oficial de Médicos de Tenerife, Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Santa Cruz de Tenerife, Spain
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Clemente-Suárez VJ, Ramírez-Goerke MI, Redondo-Flórez L, Beltrán-Velasco AI, Martín-Rodríguez A, Ramos-Campo DJ, Navarro-Jiménez E, Yáñez-Sepúlveda R, Tornero-Aguilera JF. The Impact of Anorexia Nervosa and the Basis for Non-Pharmacological Interventions. Nutrients 2023; 15:2594. [PMID: 37299557 PMCID: PMC10255390 DOI: 10.3390/nu15112594] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Anorexia nervosa is a psychiatric disorder with an unknown etiology that is characterized by an individual's preoccupation with their weight and body structure while denying the severity of their low body weight. Due to the fact that anorexia nervosa is multifaceted and may indicate the coexistence of genetic, social, hormonal, and psychiatric disorders, a description of non-pharmacological interventions can be used to ameliorate or reduce the symptoms of this condition. Consequently, the purpose of the present narrative review is to describe the profile's context in the anorexic person as well as the support they would require from their family and environment. In addition, it is aimed at examining preventative and non-pharmacological interventions, such as nutritional interventions, physical activity interventions, psychological interventions, psychosocial interventions, and physical therapy interventions. To reach the narrative review aims, a critical review was conducted utilizing both primary sources, such as scientific publications, and secondary sources, such as bibliographic indexes, web pages, and databases. Nutritional interventions include nutritional education and an individualized treatment for each patient, physical activity interventions include allowing patients to perform controlled physical activity, psychological interventions include family therapy and evaluation of the existence of other psychological disorders, psychosocial interventions include management of the relationship between the patient and social media and physical therapy interventions include relaxation massages and exercises to relieve pain. All these non-pharmacological interventions need to be individualized based on each patient's needs.
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Affiliation(s)
- Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Maria Isabel Ramírez-Goerke
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Laura Redondo-Flórez
- Department of Health Sciences, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, C/Tajo s/n, Villaviciosa de Odón, 28670 Madrid, Spain;
| | - Ana Isabel Beltrán-Velasco
- Psychology Department, Facultad de Ciencias de la Vida y la Naturaleza, Universidad Antonio de Nebrija, 28240 Madrid, Spain;
| | - Alexandra Martín-Rodríguez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Domingo Jesús Ramos-Campo
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | - Rodrigo Yáñez-Sepúlveda
- Faculty of Education and Social Sciences, Universidad Andres Bello, Viña del Mar 2520000, Chile;
| | - José Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
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Fazeli PK, Faje AT, Meenaghan E, Russell ST, Resulaj M, Lee H, Rosen CJ, Bouxsein ML, Klibanski A. IGF-1 is associated with estimated bone strength in anorexia nervosa. Osteoporos Int 2020; 31:259-265. [PMID: 31656971 PMCID: PMC7012750 DOI: 10.1007/s00198-019-05193-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/07/2019] [Indexed: 01/14/2023]
Abstract
UNLABELLED IGF-1 and leptin are two nutritionally dependent hormones associated with low bone mass in women with anorexia nervosa. Using finite element analysis, we estimated bone strength in women with anorexia nervosa and found that IGF-1 but not leptin correlated significantly with estimated bone strength in both the radius and tibia. PURPOSE Women with anorexia nervosa, a psychiatric disorder characterized by self-induced starvation and low body weight, have impaired bone formation, low bone mass, and an increased risk of fracture. IGF-1 and leptin are two nutritionally dependent hormones that have been associated with low bone mass in women with anorexia nervosa. We hypothesized that IGF-1 and leptin would also be positively associated with estimated bone strength in women with anorexia nervosa. METHODS In this cross-sectional study of 38 women (19 with anorexia nervosa and 19 normal-weight controls), we measured serum IGF-1 and leptin and performed finite element analysis of high-resolution peripheral quantitative CT images to measure stiffness and failure load of the distal radius and tibia. RESULTS IGF-1 was strongly correlated with estimated bone strength in the radius (R = 0.52, p = 0.02 for both stiffness and failure load) and tibia (R = 0.55, p = 0.01 for stiffness and R = 0.58, p = 0.01 for failure load) in the women with anorexia nervosa but not in normal-weight controls. In contrast, leptin was not associated with estimated bone strength in the group of women with anorexia nervosa or normal-weight controls. CONCLUSIONS IGF-1 is strongly associated with estimated bone strength in the radius and tibia in women with anorexia nervosa. Further studies are needed to assess whether treatment with recombinant human IGF-1 will further improve bone strength and reduce fracture risk in this population.
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Affiliation(s)
- P K Fazeli
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, 200 Lothrop Street, BST W1061, Pittsburgh, PA, 15213, USA.
| | - A T Faje
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - E Meenaghan
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - S T Russell
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - M Resulaj
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - H Lee
- Harvard Medical School, Boston, MA, USA
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - C J Rosen
- Maine Medical Center Research Institute, Scarborough, ME, USA
| | - M L Bouxsein
- Harvard Medical School, Boston, MA, USA
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - A Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Legroux I, Cortet B. Factors influencing bone loss in anorexia nervosa: assessment and therapeutic options. RMD Open 2019; 5:e001009. [PMID: 31798952 PMCID: PMC6861073 DOI: 10.1136/rmdopen-2019-001009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 12/31/2022] Open
Abstract
Decreased mineral density is one of the major complications of anorexia nervosa. The phenomenon is even more pronounced when the disease occurs during adolescence and when the duration of amenorrhoea is long. The mechanisms underlying bone loss in anorexia are complex. Oestrogen deficiency has long been considered as the main factor, but cannot explain the phenomenon on its own. The essential role of nutrition-related factors—especially leptin and adiponectin—has been reported in recent studies. Therapeutic strategies to mitigate bone involvement in anorexia are still a matter for debate. Although resumption of menses and weight recovery appear to be essential, they are not always accompanied by a total reversal of bone loss. There are no studies in the literature demonstrating that oestrogen treatment is effective, and the best results seem to have been obtained with agents that induce bone formation—such as IGF-1—especially when associated with oestrogen. As such, bone management in anorexia remains difficult, hence, the importance of early detection and multidisciplinary follow-up.
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Affiliation(s)
- Isabelle Legroux
- Department of Rheumatology and EA 4490, Lille University Hospital and University of Lille, Lille, France
| | - Bernard Cortet
- Department of Rheumatology and EA 4490, Lille University Hospital and University of Lille, Lille, France
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Abstract
Eating disorders affect a significant number of individuals across the life span and are found among all demographic groups (including all genders, socioeconomic statuses, and ethnicities). They can cause malnutrition, which can have significant effects on every organ system in the body. Cardiovascular complications are particularly dangerous and cause eating disorders to have the highest mortality rate of all mental illnesses. This article outlines the medical assessment and treatment of malnutrition due to disordered eating.
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Affiliation(s)
- Rebecka Peebles
- Eating Disorder Assessment and Treatment Program, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Roberts Center for Pediatric Research, 2716 South Street, Room 14360, Philadelphia, PA 19146, USA.
| | - Erin Hayley Sieke
- The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard 9NW55, Philadelphia, PA 19104, USA
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Abstract
Anorexia nervosa, a psychiatric disease predominantly affecting women, is characterized by self- induced starvation and a resultant low-weight state. During starvation, a number of hormonal adaptations - including hypothalamic amenorrhea and growth hormone resistance - allow for decreased energy expenditure during periods of decreased nutrient intake, but these very same adaptations also contribute to the medical complications associated with chronic starvation, including low bone mass. Almost 90% of women with anorexia nervosa have bone mineral density (BMD) values more than one-standard deviation below the mean of healthy women at peak bone mineral density and this disease is associated with a significantly increased risk of fracture. Although multiple therapies have been studied for the treatment of low bone mass in anorexia nervosa, there are currently no approved therapies and few promising long-term therapeutic options. This review will outline the mediators of low bone mass in anorexia nervosa, discuss therapies that have been studied for the treatment of low BMD in this disorder, and highlight the important challenges that remain, including the differences in bone modeling in adolescents with anorexia nervosa as compared to adults, necessitating that potential therapies be tested in these two populations separately, and the paucity of long-term therapeutic strategies for treating bone loss in this disorder.
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Affiliation(s)
- Pouneh K Fazeli
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Fazeli PK, Faje AT, Bredella MA, Polineni S, Russell S, Resulaj M, Rosen CJ, Klibanski A. Changes in marrow adipose tissue with short-term changes in weight in premenopausal women with anorexia nervosa. Eur J Endocrinol 2019; 180:189-199. [PMID: 30566901 PMCID: PMC6545162 DOI: 10.1530/eje-18-0824] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/18/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE In anorexia nervosa, a psychiatric disease characterized by self-induced starvation and a model of chronic undernutrition, levels of subcutaneous (SAT) and visceral (VAT) adipose tissue are low, whereas marrow adipose tissue (MAT) levels are elevated compared to normal-weight women. The reason for this paradoxical elevation of an adipose tissue depot in starvation is not known. We sought to understand changes in MAT in response to subacute changes in weight and to compare these changes with those of other fat depots and body composition parameters. DESIGN AND METHODS We conducted a 12-month longitudinal study including 46 premenopausal women (n = 26 with anorexia nervosa and n = 20 normal-weight controls) with a mean (s.e.m.) age of 28.2 ± 0.8 years. We measured MAT, SAT, VAT and bone mineral density (BMD) at baseline and after 12 months. RESULTS At baseline, SAT (P < 0.0001), VAT (P < 0.02) and BMD of the spine and hip (P ≤ 0.0002) were significantly lower and vertebral and metaphyseal MAT (P ≤ 0.001) significantly higher in anorexia nervosa compared to controls. Weight gain over 12 months was associated with increases not only in SAT and VAT, but also epiphyseal MAT (P < 0.03). Changes in epiphyseal MAT were positively associated with changes in BMD (P < 0.03). CONCLUSIONS In contrast to the steady state, in which MAT levels are higher in anorexia nervosa and MAT and BMD are inversely associated, short-term weight gain is associated with increases in both MAT and BMD. These longitudinal data demonstrate the dynamic nature of this fat depot and provide further evidence of its possible role in mineral metabolism.
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Affiliation(s)
- Pouneh K. Fazeli
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Alexander T. Faje
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Miriam A. Bredella
- Department of Radiology, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Sai Polineni
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA
| | - Stephen Russell
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA
| | - Megi Resulaj
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA
| | | | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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Fazeli PK, Klibanski A. The paradox of marrow adipose tissue in anorexia nervosa. Bone 2019; 118:47-52. [PMID: 29458121 PMCID: PMC6095826 DOI: 10.1016/j.bone.2018.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 12/19/2022]
Abstract
Anorexia nervosa (AN) is a psychiatric disorder characterized by inappropriate nutrient intake resulting in low body weight. Multiple hormonal adaptations facilitate decreased energy expenditure in this state of caloric deprivation including non-thyroidal illness syndrome, growth hormone resistance, and hypogonadotropic hypogonadism. Although these hormonal adaptations confer a survival advantage during periods of negative energy balance, they contribute to the long-term medical complications associated with AN, the most common of which is significant bone loss and an increased risk of fracture. In recent years, marrow adipose tissue (MAT) has emerged as an important potential determinant of the low bone mass state characteristic of AN. Unlike subcutaneous and visceral adipose tissue depots which are low in AN, MAT levels are paradoxically elevated and are inversely associated with BMD. In this review, we discuss what is known about MAT in AN and the proposed hormonal determinants of this adipose tissue depot.
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Affiliation(s)
- Pouneh K Fazeli
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Fazeli PK, Klibanski A. Effects of Anorexia Nervosa on Bone Metabolism. Endocr Rev 2018; 39:895-910. [PMID: 30165608 PMCID: PMC6226604 DOI: 10.1210/er.2018-00063] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 08/21/2018] [Indexed: 01/14/2023]
Abstract
Anorexia nervosa is a psychiatric disease characterized by a low-weight state due to self-induced starvation. This disorder, which predominantly affects women, is associated with hormonal adaptations that minimize energy expenditure in the setting of low nutrient intake. These adaptations include GH resistance, functional hypothalamic amenorrhea, and nonthyroidal illness syndrome. Although these adaptations may be beneficial to short-term survival, they contribute to the significant and often persistent morbidity associated with this disorder, including bone loss, which affects >85% of women. We review the hormonal adaptions to undernutrition, review hormonal treatments that have been studied for both the underlying disorder as well as for the associated decreased bone mass, and discuss the important challenges that remain, including the lack of long-term treatments for bone loss in this chronic disorder and the fact that despite recovery, many individuals who experience bone loss as adolescents have chronic deficits and an increased risk of fracture in adulthood.
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Affiliation(s)
- Pouneh K Fazeli
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Legroux-Gérot I, Vignau J, Viltart O, Hardouin P, Chauveau C, Cortet B. Adipokines and bone status in a cohort of anorexic patients. Joint Bone Spine 2018; 86:95-101. [PMID: 29653285 DOI: 10.1016/j.jbspin.2018.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 03/21/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Bone loss in anorexia nervosa (AN) is multifactorial; its mechanisms are not yet clearly understood and may vary depending on disease duration and severity. To determine to what extent adipokines may be involved in the bone alterations found in anorexic patients, we evaluated plasma levels for leptin, adiponectin and Pref-1 against other clinical and biological parameters in a population of anorexic patients split according to weight and bone status. METHODS Plasma concentrations of leptin, total adiponectin, high molecular weight (HMW) adiponectin, and Pref-1 were measured. The ratio of HMW adiponectin to total adiponectin - HMW (percentage) - was calculated. We divided our population into 5 groups with different phenotypes characterizing the severity of the disease and/or the severity of bone involvement: 1 - Normal BMD and body mass index (BMI): recovery from AN; 2 - Osteopenia (-2<Z-score<-1) and BMI>17kg/m2; 3 - Osteopenia and BMI≤17kg/m2; 4 - Osteoporosis (Z-score≤-2) and BMI>17kg/m2; 5 - Osteoporosis and BMI≤17kg/m2. RESULTS The study involved 80 anorexia nervosa patients. Mean BMI was 16.8±2.4kg/m2. No significant difference was found in total and HMW adiponectin plasma concentrations between the 5 groups. HMW (percentage) was significantly higher in group 5 compared to group 1. Leptin was significantly lower in groups 3 and 5 compared to the other groups. For the whole group femoral neck and hip BMD correlated negatively with total adiponectin and HMW adiponectin. No correlation was found between BMD (whatever the site) and plasma leptin. Multivariate analysis revealed that 2 factors - leptin and BMI - explained 10% of the variance in spine BMD. For femoral neck BMD, the 2 explanatory factors were BMI and total adiponectin which explained 14% of the variance in BMD. For total hip BMD, 27% of the variance in BMD was explained by 3 factors: leptin, BMI, and total adiponectin. CONCLUSION Bone status in anorexia nervosa is mainly determined by BMI, leptin and adiponectin.
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Affiliation(s)
- Isabelle Legroux-Gérot
- Department of rheumatology, hôpital Roger-Salengro, CHRU de Lille, 59000 Lille, France; EA4490, PMOI, pathophysiology of inflammatory bone diseases, université de Lille, université Littoral Côte d'Opale, 59000 Lille, France.
| | - Jean Vignau
- Department of addiction medicine, hôpital Fontan, CHRU de Lille, 59000 Lille, France
| | - Odile Viltart
- Inserm, UMR-S1172, Jean-Pierre-Aubert research center neurosciences and cancer (JPArc), université de Lille, CHU de Lille, 59000 Lille, France
| | - Pierre Hardouin
- EA4490, PMOI, pathophysiology of inflammatory bone diseases, université de Lille, université Littoral Côte d'Opale, 59000 Lille, France
| | - Christophe Chauveau
- EA4490, PMOI, pathophysiology of inflammatory bone diseases, université de Lille, université Littoral Côte d'Opale, 59000 Lille, France
| | - Bernard Cortet
- Department of rheumatology, hôpital Roger-Salengro, CHRU de Lille, 59000 Lille, France; EA4490, PMOI, pathophysiology of inflammatory bone diseases, université de Lille, université Littoral Côte d'Opale, 59000 Lille, France
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Achamrah N, Coëffier M, Jésus P, Charles J, Rimbert A, Déchelotte P, Grigioni S. Bone Mineral Density after Weight Gain in 160 Patients with Anorexia Nervosa. Front Nutr 2017; 4:46. [PMID: 29034241 PMCID: PMC5626930 DOI: 10.3389/fnut.2017.00046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 09/14/2017] [Indexed: 12/14/2022] Open
Abstract
Low bone mineral density (BMD) is a frequent complication in anorexia nervosa (AN). There are controversial points of views regarding the restoration of bone mineralization after recovery in AN. We aimed to assess changes of BMD at 3 years in patients with AN and to explore the relationships between body composition, physical activity, and BMD. Patients with AN were included from 2009 to 2011 in a first visit (T0) with evaluation of weight, height, body mass index (BMI), body composition [fat mass (FM) and fat-free mass], and BMD. Those who had low BMD, either osteoporosis or osteopenia, were admitted in a second visit (T1) to carry out a new bone densitometry examination and body composition; they were also asked for their physical activity. At T0, our study involved 160 patients. Low BMD was observed in 53.6% of them and significant factors associated with demineralization were lower BMIs (16.5 ± 2.1 vs 17.3 ± 2.3 kg/m2, p = 0.01) and higher duration of AN (11.4 ± 10.5 vs 6.4 ± 6.5 years, p = 0.001). At 3 years follow-up (T1), 42 patients were involved and no significant changes in BMD were observed despite body weight increase (3.8 ± 6.1 kg). Interestingly, FM gain was a significant factor associated with BMD improvement at follow-up (8.0 ± 9.1 vs 3.0 ± 3.5 kg, p = 0.02). Our findings suggest that the restoration of normal bone values is not related to the increase of body weight, at least after 3 years. FM seems to play an important role in the pathophysiological mechanism of osteoporosis and osteopenia in AN.
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Affiliation(s)
- Najate Achamrah
- Nutrition Unit, Rouen University Hospital, Rouen, France.,Normandie University, UR, INSERM U1073, Rouen, France.,Institute for Research and Innovation in Biomedicine, Rouen, France
| | - Moïse Coëffier
- Nutrition Unit, Rouen University Hospital, Rouen, France.,Normandie University, UR, INSERM U1073, Rouen, France.,Institute for Research and Innovation in Biomedicine, Rouen, France
| | - Pierre Jésus
- Normandie University, UR, INSERM U1073, Rouen, France.,Institute for Research and Innovation in Biomedicine, Rouen, France
| | | | - Agnès Rimbert
- Nutrition Unit, Rouen University Hospital, Rouen, France
| | - Pierre Déchelotte
- Nutrition Unit, Rouen University Hospital, Rouen, France.,Normandie University, UR, INSERM U1073, Rouen, France.,Institute for Research and Innovation in Biomedicine, Rouen, France
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14
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Thornton D, Gordon CM. Restrictive Eating Disorders and Skeletal Health in Adolescent Girls and Young Women. Calcif Tissue Int 2017; 100:449-460. [PMID: 27339670 PMCID: PMC9767748 DOI: 10.1007/s00223-016-0164-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/10/2016] [Indexed: 12/19/2022]
Abstract
This article reviews the effects of restrictive eating disorders on bone health. The relationship between eating disorders and amenorrhea is discussed in detail. The pathologic impact of malnutrition on bone is explored by examining the results of studies using various available imaging techniques. The multiple hormonal alterations seen in adolescents and young women with anorexia nervosa are reviewed, as well as how these alterations may influence bone turnover, density, structure, and strength. The diagnostic clinical evaluation for adolescents and young women with these disorders is also outlined. Available treatment options, including those that hold promise for efficacy, as well as those we deemed to be ineffective, are considered from both the clinical and mechanistic standpoints. Finally, future research opportunities are offered, including intriguing work in the area of fat and bone interactions.
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Affiliation(s)
- Darcey Thornton
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave MLC 4000, Cincinnati, OH, 45229, USA
| | - Catherine M Gordon
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave MLC 4000, Cincinnati, OH, 45229, USA.
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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15
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Maïmoun L, Guillaume S, Lefebvre P, Philibert P, Bertet H, Picot MC, Gaspari L, Paris F, Seneque M, Dupuys AM, Courtet P, Thomas E, Mariano-Goulart D, Bringer J, Renard E, Sultan C. Evidence of a link between resting energy expenditure and bone remodelling, glucose homeostasis and adipokine variations in adolescent girls with anorexia nervosa. Osteoporos Int 2016; 27:135-46. [PMID: 26245848 DOI: 10.1007/s00198-015-3223-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED Low bone mass is a consequence of anorexia nervosa (AN). This study assessed the effects of energy deficiency on various bone and hormonal parameters. The interrelationships between energy deficiency and bone remodelling, glucose homeostasis and adipokines underscore the importance of preventing energy deficiency to limit demineralisation and hormonal alterations in AN patients. INTRODUCTION Low areal bone mineral density (aBMD) is a well-known consequence of AN. However, the impact of reduced energy expenditure on bone metabolism is unknown. This study assessed the effects of energy deficiency on bone remodelling and its potential interactions with glucose homeostasis and adipose tissue-derived hormones in AN, a clinical model for reduced energy expenditure. METHODS Fifty women with AN and 50 age-matched controls (mean age 18.1 ± 2.7 and 18.0 ± 2.1 years, respectively) were enrolled. aBMD was determined with DXA. Resting energy expenditure (REEm), a marker of energy status, was indirectly assessed by calorimetry. Bone turnover markers, undercarboxylated osteocalcin (ucOC), parameters of glucose homeostasis, adipokines and growth factors were concomitantly evaluated. RESULTS AN patients presented low aBMD at all bone sites. REEm, bone formation markers, ucOC, glucose, insulin, HOMA-IR, leptin and IGF-1 were significantly reduced, whereas the bone resorption marker, leptin receptor (sOB-R) and adiponectin were elevated in AN compared with CON. In AN patients, REEm was positively correlated with weight, BMI, whole body (WB) fat mass, WB fat-free soft tissue, markers of bone formation, glucose, insulin, HOMA-IR, leptin and IGF-1 and negatively correlated with the bone resorption marker and sOB-R. Biological parameters, aBMD excepted, appeared more affected by the weight variation in the last 6 months than by the disease duration. CONCLUSIONS The strong interrelationships between REEm and bone remodelling, glucose homeostasis and adipokines underscore the importance of preventing energy deficiency to limit short- and long-term bone demineralisation and hormonal alterations in AN patients.
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Affiliation(s)
- L Maïmoun
- Service de Médecine Nucléaire, Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHRU) Montpellier et Université Montpellier 1 (UMI), 34295, Montpellier, France
- Physiologie et Médecine Expérimentale du Cœur et des Muscles (PhyMedExp), University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier, France
| | - S Guillaume
- Département d'Urgence et Post-Urgence Psychiatrique, Hôpital Lapeyronie, CHRU Montpellier, UMI, INSERM U1061, 34295, Montpellier, France
| | - P Lefebvre
- Department of Endocrinology, Diabetes, Nutrition, Hôpital Lapeyronie, CHRU Montpellier, 34295, Montpellier, France
| | - P Philibert
- Departement de Biochimie et d'Hormonologie, Hôpital Lapeyronie, CHRU Montpellier, 34295, Montpellier, France
| | - H Bertet
- Unité de Recherche Clinique et Epidémiologie, Hôpital Lapeyronie, CHRU Montpellier, 34295, Montpellier, France
| | - M-C Picot
- Unité de Recherche Clinique et Epidémiologie, Hôpital Lapeyronie, CHRU Montpellier, 34295, Montpellier, France
- CIC INSERM 1411, Hôpital Saint Eloi, CHRU Montpellier, 34295, Montpellier cedex 5, France
| | - L Gaspari
- Département de Pédiatrie, Hôpital Caremeau, CHRU Nîmes, 30000, Nîmes, France
| | - F Paris
- Departement de Biochimie et d'Hormonologie, Hôpital Lapeyronie, CHRU Montpellier, 34295, Montpellier, France
- Unité d'Endocrinologie et Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital Arnaud de Villeneuve, 191 avenue Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - M Seneque
- Département d'Urgence et Post-Urgence Psychiatrique, Hôpital Lapeyronie, CHRU Montpellier, UMI, INSERM U1061, 34295, Montpellier, France
| | - A-M Dupuys
- Departement de Biochimie et d'Hormonologie, Hôpital Lapeyronie, CHRU Montpellier, 34295, Montpellier, France
| | - P Courtet
- Département d'Urgence et Post-Urgence Psychiatrique, Hôpital Lapeyronie, CHRU Montpellier, UMI, INSERM U1061, 34295, Montpellier, France
| | - E Thomas
- Service de Rhumatologie, Hôpital Lapeyronie, CHRU Montpellier, 34295, Montpellier, France
| | - D Mariano-Goulart
- Service de Médecine Nucléaire, Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHRU) Montpellier et Université Montpellier 1 (UMI), 34295, Montpellier, France
- Physiologie et Médecine Expérimentale du Cœur et des Muscles (PhyMedExp), University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295, Montpellier, France
| | - J Bringer
- Department of Endocrinology, Diabetes, Nutrition, Hôpital Lapeyronie, CHRU Montpellier, 34295, Montpellier, France
| | - E Renard
- Department of Endocrinology, Diabetes, Nutrition, Hôpital Lapeyronie, CHRU Montpellier, 34295, Montpellier, France
- CIC INSERM 1411, Hôpital Saint Eloi, CHRU Montpellier, 34295, Montpellier cedex 5, France
- Institut de Génomique Fonctionnelle, CNRS UMR 5203/INSERM U1161/Université Montpellier, Montpellier, France
| | - C Sultan
- Unité d'Endocrinologie et Gynécologie Pédiatrique, Département de Pédiatrie, Hôpital Arnaud de Villeneuve, 191 avenue Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France.
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16
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Thomas SDC, Morris HA, Nordin BEC. Acute effect of a supplemented milk drink on bone metabolism in healthy postmenopausal women is influenced by the metabolic syndrome. Nutr J 2015; 14:99. [PMID: 26407553 PMCID: PMC4582712 DOI: 10.1186/s12937-015-0092-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 09/21/2015] [Indexed: 01/19/2023] Open
Abstract
Background Dietary factors acutely influence the rate of bone resorption, as demonstrated by changes in serum bone resorption markers. Dietary calcium exerts its effect by reducing parathyroid hormone levels while other components induce gut incretin hormones both of which reduce bone resorption markers. The impact of dietary calcium on bone turnover when energy metabolism is modulated such as in metabolic syndrome has not been explored. This study was designed investigate whether metabolic syndrome or a greater amount of visceral fat influences the impact of dietary calcium on bone turnover. Methods The influence of the metabolic syndrome on effects of dietary calcium on bone turnover in community dwelling postmenopausal women was studied. Twenty five volunteers consumed 200 mL of low fat milk with additional 560 mg calcium (one serve of Milo®) in the evening on one occasion. Fasting morning serum biochemistry before and after the milk drink with lumber spine bone density, bone mineral content, fat and lean mass using dual energy X-ray absorptiometry (DXA) and waist circumference were measured. The women were divided into 2 groups using the waist measurement of 88 cm, as a criterion of metabolic syndrome. Student’s t tests were used to determine significant differences between the 2 groups. Results The lumbar spine mineral content was higher in women with metabolic syndrome. After consuming the milk drink, serum bone resorption marker C terminal telopeptide (CTX) was suppressed to a significant extent in women with metabolic syndrome compared to those without. Conclusions The results suggests that dietary calcium may exert a greater suppression of bone resorption in post-menopausal women with metabolic syndrome than healthy women. Despite substantial evidence for close links between energy metabolism and bone metabolism this is the first report suggesting visceral fat or metabolic syndrome may influence the effects of dietary calcium on bone metabolism.
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Affiliation(s)
- Sunethra D C Thomas
- Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia. .,Endocrine and Metabolic Unit, Royal Adelaide Hospital, Level 7, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia.
| | - Howard A Morris
- School of Pharmacy and Health Sciences, University of South Australia, Adelaide, South Australia, Australia. .,Chemical Pathology, SA Pathology, Adelaide, South Australia, Australia.
| | - B E C Nordin
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Level 7, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia
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17
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Méquinion M, Caron E, Zgheib S, Stievenard A, Zizzari P, Tolle V, Cortet B, Lucas S, Prévot V, Chauveau C, Viltart O. Physical activity: benefit or weakness in metabolic adaptations in a mouse model of chronic food restriction? Am J Physiol Endocrinol Metab 2015; 308:E241-55. [PMID: 25465889 DOI: 10.1152/ajpendo.00340.2014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In restrictive-type anorexia nervosa (AN) patients, physical activity is usually associated with food restriction, but its physiological consequences remain poorly characterized. In female mice, we evaluated the impact of voluntary physical activity with/without chronic food restriction on metabolic and endocrine parameters that might contribute to AN. In this protocol, FRW mice (i.e., food restriction with running wheel) reached a crucial point of body weight loss (especially fat mass) faster than FR mice (i.e., food restriction only). However, in contrast to FR mice, their body weight stabilized, demonstrating a protective effect of a moderate, regular physical activity. Exercise delayed meal initiation and duration. FRW mice displayed food anticipatory activity compared with FR mice, which was strongly diminished with the prolongation of the protocol. The long-term nature of the protocol enabled assessment of bone parameters similar to those observed in AN patients. Both restricted groups adapted their energy metabolism differentially in the short and long term, with less fat oxidation in FRW mice and a preferential use of glucose to compensate for the chronic energy imbalance. Finally, like restrictive AN patients, FRW mice exhibited low leptin levels, high plasma concentrations of corticosterone and ghrelin, and a disruption of the estrous cycle. In conclusion, our model suggests that physical activity has beneficial effects on the adaptation to the severe condition of food restriction despite the absence of any protective effect on lean and bone mass.
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Affiliation(s)
- Mathieu Méquinion
- University Lille (ULCO, USTL, Lille2), Lille, France; Development and Plasticity of Postnatal Brain, UMR 837 Institut National de la Sante et de la Recherche Medicale (INSERM), Lille, France; Physiopathology of Inflammatory Bone diseases, EA4490, Boulogne sur Mer, France
| | - Emilie Caron
- Development and Plasticity of Postnatal Brain, UMR 837 Institut National de la Sante et de la Recherche Medicale (INSERM), Lille, France
| | - Sara Zgheib
- University Lille (ULCO, USTL, Lille2), Lille, France; Physiopathology of Inflammatory Bone diseases, EA4490, Boulogne sur Mer, France
| | - Aliçia Stievenard
- University Lille (ULCO, USTL, Lille2), Lille, France; Molecular Events Associated With Early stages of Parkinson's Disease UMR 837 INSERM, Lille, France
| | - Philippe Zizzari
- Psychiatry and Neurosciences Center, UMR 894 INSERM, Paris, France; and
| | - Virginie Tolle
- Psychiatry and Neurosciences Center, UMR 894 INSERM, Paris, France; and
| | - Bernard Cortet
- University Lille (ULCO, USTL, Lille2), Lille, France; Department of Rheumatology, Centre Hospitalier Universitaire Régional, Lille, France
| | - Stéphanie Lucas
- University Lille (ULCO, USTL, Lille2), Lille, France; Physiopathology of Inflammatory Bone diseases, EA4490, Boulogne sur Mer, France
| | - Vincent Prévot
- University Lille (ULCO, USTL, Lille2), Lille, France; Development and Plasticity of Postnatal Brain, UMR 837 Institut National de la Sante et de la Recherche Medicale (INSERM), Lille, France
| | - Christophe Chauveau
- University Lille (ULCO, USTL, Lille2), Lille, France; Physiopathology of Inflammatory Bone diseases, EA4490, Boulogne sur Mer, France
| | - Odile Viltart
- University Lille (ULCO, USTL, Lille2), Lille, France; Development and Plasticity of Postnatal Brain, UMR 837 Institut National de la Sante et de la Recherche Medicale (INSERM), Lille, France;
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18
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Abstract
Anorexia nervosa (AN) is a psychiatric disorder characterized by self-induced starvation with a lifetime prevalence of 2.2% in women. The most common medical co-morbidity in women with AN is bone loss, with over 85% of women having bone mineral density values more than one standard deviation below an age comparable mean. The low bone mass in AN is due to multiple hormonal adaptations to under nutrition, including hypothalamic amenorrhea and growth hormone resistance. Importantly, this low bone mass is also associated with a seven-fold increased risk of fracture. Therefore, strategies to effectively prevent bone loss and increase bone mass are critical. We will review hormonal adaptations that contribute to bone loss in this population as well as promising new therapies that may increase bone mass and reduce fracture risk in AN.
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Affiliation(s)
- Pouneh K Fazeli
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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19
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Zgheib S, Méquinion M, Lucas S, Leterme D, Ghali O, Tolle V, Zizzari P, Bellefontaine N, Legroux-Gérot I, Hardouin P, Broux O, Viltart O, Chauveau C. Long-term physiological alterations and recovery in a mouse model of separation associated with time-restricted feeding: a tool to study anorexia nervosa related consequences. PLoS One 2014; 9:e103775. [PMID: 25090643 PMCID: PMC4121212 DOI: 10.1371/journal.pone.0103775] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 07/02/2014] [Indexed: 12/15/2022] Open
Abstract
Background Anorexia nervosa is a primary psychiatric disorder, with non-negligible rates of mortality and morbidity. Some of the related alterations could participate in a vicious cycle limiting the recovery. Animal models mimicking various physiological alterations related to anorexia nervosa are necessary to provide better strategies of treatment. Aim To explore physiological alterations and recovery in a long-term mouse model mimicking numerous consequences of severe anorexia nervosa. Methods C57Bl/6 female mice were submitted to a separation-based anorexia protocol combining separation and time-restricted feeding for 10 weeks. Thereafter, mice were housed in standard conditions for 10 weeks. Body weight, food intake, body composition, plasma levels of leptin, adiponectin, IGF-1, blood levels of GH, reproductive function and glucose tolerance were followed. Gene expression of several markers of lipid and energy metabolism was assayed in adipose tissues. Results Mimicking what is observed in anorexia nervosa patients, and despite a food intake close to that of control mice, separation-based anorexia mice displayed marked alterations in body weight, fat mass, lean mass, bone mass acquisition, reproductive function, GH/IGF-1 axis, and leptinemia. mRNA levels of markers of lipogenesis, lipolysis, and the brown-like adipocyte lineage in subcutaneous adipose tissue were also changed. All these alterations were corrected during the recovery phase, except for the hypoleptinemia that persisted despite the full recovery of fat mass. Conclusion This study strongly supports the separation-based anorexia protocol as a valuable model of long-term negative energy balance state that closely mimics various symptoms observed in anorexia nervosa, including metabolic adaptations. Interestingly, during a recovery phase, mice showed a high capacity to normalize these parameters with the exception of plasma leptin levels. It will be interesting therefore to explore further the central and peripheral effects of the uncorrected hypoleptinemia during recovery from separation-based anorexia.
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Affiliation(s)
- Sara Zgheib
- Université Lille Nord de France, Boulogne sur Mer, France
- Physiopathologie des Maladies Osseuses Inflammatoires, Boulogne sur Mer, France
| | - Mathieu Méquinion
- Université Lille Nord de France, Boulogne sur Mer, France
- Physiopathologie des Maladies Osseuses Inflammatoires, Boulogne sur Mer, France
- UMR INSERM 837, Développement et Plasticité du Cerveau Post-natal, Lille, France
| | - Stéphanie Lucas
- Université Lille Nord de France, Boulogne sur Mer, France
- Physiopathologie des Maladies Osseuses Inflammatoires, Boulogne sur Mer, France
| | - Damien Leterme
- Université Lille Nord de France, Boulogne sur Mer, France
- Physiopathologie des Maladies Osseuses Inflammatoires, Boulogne sur Mer, France
| | - Olfa Ghali
- Université Lille Nord de France, Boulogne sur Mer, France
- Physiopathologie des Maladies Osseuses Inflammatoires, Boulogne sur Mer, France
| | - Virginie Tolle
- UMR-S 894 INSERM, Centre de Psychiatrie et Neurosciences, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Philippe Zizzari
- UMR-S 894 INSERM, Centre de Psychiatrie et Neurosciences, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Nicole Bellefontaine
- Université Lille Nord de France, Boulogne sur Mer, France
- UMR INSERM 837, Développement et Plasticité du Cerveau Post-natal, Lille, France
| | - Isabelle Legroux-Gérot
- Université Lille Nord de France, Boulogne sur Mer, France
- Physiopathologie des Maladies Osseuses Inflammatoires, Boulogne sur Mer, France
- Service de Rhumatologie, Hôpital Roger Salengro, CHU Lille, France
| | - Pierre Hardouin
- Université Lille Nord de France, Boulogne sur Mer, France
- Physiopathologie des Maladies Osseuses Inflammatoires, Boulogne sur Mer, France
| | - Odile Broux
- Université Lille Nord de France, Boulogne sur Mer, France
- Physiopathologie des Maladies Osseuses Inflammatoires, Boulogne sur Mer, France
| | - Odile Viltart
- Université Lille Nord de France, Boulogne sur Mer, France
- UMR INSERM 837, Développement et Plasticité du Cerveau Post-natal, Lille, France
- Université de Lille1, Villeneuve d’Ascq, France
| | - Christophe Chauveau
- Université Lille Nord de France, Boulogne sur Mer, France
- Physiopathologie des Maladies Osseuses Inflammatoires, Boulogne sur Mer, France
- * E-mail:
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20
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Abstract
Anorexia nervosa (AN), a psychiatric disorder predominantly affecting young women, is characterized by self-imposed, chronic nutritional deprivation and distorted body image. AN is associated with a number of medical comorbidities including low bone mass. The low bone mass in AN is due to an uncoupling of bone formation and bone resorption, which is the result of hormonal adaptations aimed at decreasing energy expenditure during periods of low energy intake. Importantly, the low bone mass in AN is associated with a significant risk of fractures and therefore treatments to prevent bone loss are critical. In this review, we discuss the hormonal determinants of low bone mass in AN and treatments that have been investigated in this population.
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Affiliation(s)
- Pouneh K Fazeli
- Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 457, Boston, MA, 02114, USA,
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21
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New insights into adhesion signaling in bone formation. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2013; 305:1-68. [PMID: 23890379 DOI: 10.1016/b978-0-12-407695-2.00001-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mineralized tissues that are protective scaffolds in the most primitive species have evolved and acquired more specific functions in modern animals. These are as diverse as support in locomotion, ion homeostasis, and precise hormonal regulation. Bone formation is tightly controlled by a balance between anabolism, in which osteoblasts are the main players, and catabolism mediated by the osteoclasts. The bone matrix is deposited in a cyclic fashion during homeostasis and integrates several environmental cues. These include diffusible elements that would include estrogen or growth factors and physicochemical parameters such as bone matrix composition, stiffness, and mechanical stress. Therefore, the microenvironment is of paramount importance for controlling this delicate equilibrium. Here, we provide an overview of the most recent data highlighting the role of cell-adhesion molecules during bone formation. Due to the very large scope of the topic, we focus mainly on the role of the integrin receptor family during osteogenesis. Bone phenotypes of some deficient mice as well as diseases of human bones involving cell adhesion during this process are discussed in the context of bone physiology.
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22
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Legroux-Gérot I, Vignau J, d'Herbomez M, Flipo RM, Cortet B. Predictive factors of change in BMD at 1 and 2 years in women with anorexia nervosa: a study of 146 cases. Osteoporos Int 2012; 23:2855-61. [PMID: 22349911 DOI: 10.1007/s00198-012-1919-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 01/10/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED Bone mineral density (BMD; measured by DXA) changes were observed at all sites at 1 year in 146 patients with anorexia nervosa. Four independent factors accounted for the variation in BMD at the spine: duration of anorexia, bone-specific alkaline phosphatase (BAP), cross-linked carboxyterminal telopeptide region of type I collagen (ICTP), and triiodothyronine (T3). No change in BMD was observed from 1 to 2 years during follow-up. INTRODUCTION The purpose of this study was to assess changes in BMD at 1 and 2 years in anorexia nervosa patients, and to explore the relationships between change in BMD and various clinical and biological parameters measured at the first visit. METHODS BMD was measured in anorexia nervosa patients at inclusion, at 1-year follow-up (n = 146) and at 2-year follow-up (n = 89). RESULTS Bone loss was observed at all sites at 1 year. When multivariate analyses were performed, four independent factors accounted for the variation in BMD at the spine: duration of anorexia nervosa, BAP, ICTP, and T3. At the total hip site, leptin level was the main factor accounting for the variation in BMD. Strong correlations were also observed between weight at 1 year and change in BMD at 2 years. At the 2-year follow-up, no significant change in BMD was observed at the spine or femoral neck. In patients who were no longer amenorrheic at 1 year, a significant improvement in BMD at 2 years was observed at the total hip (+1.2%, p = 0.02) and femoral neck (+3.7%, p = 0.02). Similarly, in patients with a body mass index >17 kg/m(2) at 1 year, an improvement in BMD at the total hip at 2 years was observed (+3%, p = 0.02) CONCLUSION Bone loss in anorexia nervosa patients occurs at an early stage, and the factors influencing such are different at the spine and hip.
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Affiliation(s)
- I Legroux-Gérot
- Department of Rheumatology, Roger Salengro Hospital, CHU Lille, 59037, Lille Cédex, France.
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23
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Abstract
In anorexia nervosa, under-nutrition and weight regulatory behaviours such as vomiting and laxative abuse can lead to a range of biochemical problems. Hypokalaemia is the most common electrolyte abnormality. Metabolic alkalosis occurs in patients who vomit or abuse diuretics and acidosis in those misusing laxatives. Hyponatraemia is often due to excessive water ingestion, but may also occur in chronic energy deprivation or diuretic misuse. Urea and creatinine are generally low and normal concentrations may mask dehydration or renal dysfunction. Abnormalities of liver enzymes are predominantly characterized by elevation of aminotransferases, which may occur before or during refeeding. The serum albumin is usually normal, even in severely malnourished patients. Amenorrhoea is due to hypogonadotrophic hypogonadism. Reduced concentrations of free T4 and free T3 are frequently reported and T4 is preferentially converted to reverse T3. Cortisol is elevated but the response to adrenocorticotrophic hormone is normal. Hypoglycaemia is common. Hypercholesterolaemia is a common finding but its significance for cardiovascular risk is uncertain. A number of micronutrient deficiencies can occur. Other abnormalities include hyperamylasaemia, hypercarotenaemia and elevated creatine kinase. There is an increased prevalence of eating disorders in type 1 diabetes and the intentional omission of insulin is associated with impaired metabolic control. Refeeding may produce electrolyte abnormalities, hyper- and hypoglycaemia, acute thiamin depletion and fluid balance disturbance; careful biochemical monitoring and thiamin replacement are therefore essential during refeeding. Future research should address the management of electrolyte problems, the role of leptin and micronutrients, and the possible use of biochemical markers in risk stratification.
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Affiliation(s)
- Anthony P Winston
- Eating Disorders Unit, Woodleigh Beeches Centre, Warwick Hospital, Warwick, UK
- Health Sciences Research Institute, University of Warwick, Coventry, UK
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Fazeli PK, Klibanski A. Neuroendocrine dysregulation and the growth hormone-IGF-1 axis in anorexia nervosa. Expert Rev Endocrinol Metab 2012; 7:223-231. [PMID: 30764013 DOI: 10.1586/eem.12.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Anorexia nervosa is a common psychiatric disorder characterized by extreme, self-induced starvation and is associated with a number of medical complications, including significant loss of bone mass. Disruption of the hypothalamic-pituitary axis has been demonstrated in anorexia nervosa and contributes to both loss of established bone mass in adults and failure to accrue normal bone mass in adolescents. Anorexia nervosa is associated with the development of a state of acquired growth hormone (GH) resistance, characterized by low IGF-1 and elevated GH levels, which may be mediated in part by FGF-21. Administration of supraphysiologic recombinant human GH does not result in an increase in markers of bone formation. However, treatment with recombinant human IGF-1, in combination with an oral contraceptive, increases markers of bone formation as well as bone mineral density, and may be a novel way to treat the bone loss associated with anorexia nervosa.
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Affiliation(s)
- Pouneh K Fazeli
- a Neuroendocrine Unit, Bulfinch 457B, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
| | - Anne Klibanski
- b Neuroendocrine Unit, Bulfinch 457B, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA.
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25
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Abstract
PURPOSE OF REVIEW Anorexia nervosa is associated with low bone mineral density (BMD), concerning for an increased risk of fractures, and decreased bone accrual in adolescents, concerning for suboptimal peak bone mass. This review discusses causes of impaired bone health in anorexia nervosa and potential therapeutic strategies. RECENT FINDINGS Low BMD in anorexia nervosa is consequent to decreased lean mass, hypogonadism, low insulin-like growth factor-1 (IGF-1), relative hypercortisolemia and alterations in hormones impacted by energy availability. Weight gain causes some improvement in bone accrual, but not to the extent observed in controls, and vitamin D supplementation does not increase BMD. Oral estrogen is not effective in increasing BMD, likely from IGF-1 suppressive effects. In contrast, transdermal estrogen replacement is effective in increasing bone accrual in adolescents with anorexia nervosa, although not to the extent seen in controls. Recombinant human IGF-1 increases bone formation in adolescents, and with oral estrogen increases BMD in adults with anorexia nervosa. Bisphosphonates increase BMD in adults, but not in adolescents, and should be used cautiously given their long half-life. SUMMARY Further investigation is necessary to explore therapies for low BMD in anorexia nervosa. Weight gain is to be encouraged. Transdermal estrogen in adolescents, and bisphosphonates in adults, have a potential therapeutic role.
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Affiliation(s)
- Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Iwamoto J, Sato Y, Uzawa M, Takeda T, Matsumoto H. Seven years' experience with etidronate in a woman with anorexia nervosa and vertebral fractures. Ther Clin Risk Manag 2011; 7:275-81. [PMID: 21845050 PMCID: PMC3150473 DOI: 10.2147/tcrm.s21357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We report the case of a 30-year-old Japanese woman with anorexia nervosa and vertebral fractures who was treated with etidronate. She had a history of anorexia nervosa, chronic back pain, osteoporosis, and multiple vertebral fractures (morphometric fractures) that responded poorly to treatment with alfacalcidol (1 μg daily) for 1 year and was treated with cyclical etidronate (200 mg for 2 weeks every 3 months) for 7 years. The lumbar spine bone mineral density (BMD) increased, and the serum alkaline phosphatase and urinary cross-linked N-terminal telopeptides of type I collagen levels and back pain decreased. During the 7-year period of treatment with etidronate, no osteoporotic fractures occurred. The patient experienced neither renal dysfunction nor hyperparathyroidism caused by osteomalacia. No gastrointestinal tract symptoms were observed. Thus, etidronate was effective for increasing the lumbar spine BMD and reducing back pain over a 7-year period without causing either osteoporotic fractures or adverse events.
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Affiliation(s)
- Jun Iwamoto
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
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Schulze UME, Schuler S, Schlamp D, Schneider P, Mehler-Wex C. Bone mineral density in partially recovered early onset anorexic patients - a follow-up investigation. Child Adolesc Psychiatry Ment Health 2010; 4:20. [PMID: 20615217 PMCID: PMC2914652 DOI: 10.1186/1753-2000-4-20] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 07/08/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIMS There still is a lack of prospective studies on bone mineral development in patients with a history of early onset Anorexia nervosa (AN). Therefore we assessed associations between bone mass accrual and clinical outcomes in a former clinical sample. In addition to an expected influence of regular physical activity and hormone replacement therapy, we explored correlations with nutritionally dependent hormones. METHODS 3-9 years (mean 5.2 +/- 1.7) after hospital discharge, we re-investigated 52 female subjects with a history of early onset AN. By means of a standardized approach, we evaluated the general outcome of AN. Moreover, bone mineral content (BMC) and bone mineral density (BMD) as well as lean and fat mass were measured by dual-energy x-ray absorptiometry (DXA). In a substudy, we measured the serum concentrations of leptin and insulin-like growth factor-I (IGF-I). RESULTS The general outcome of anorexia nervosa was good in 50% of the subjects (BMI >/= 17.5 kg/m2, resumption of menses). Clinical improvement was correlated with BMC and BMD accrual (chi2 = 5.62/chi2 = 6.65, p = 0.06 / p = 0.036). The duration of amenorrhea had a negative correlation with BMD (r = -.362; p < 0.01), but not with BMC. Regular physical activity tended to show a positive effect on bone recovery, but the effect of hormone replacement therapy was not significant. Using age-related standards, the post-discharge sample for the substudy presented IGF-I levels below the 5th percentile. IGF-I serum concentrations corresponded to the general outcome of AN. By contrast, leptin serum concentrations showed great variability. They correlated with BMC and current body composition parameters. CONCLUSIONS Our results from the main study indicate a certain adaptability of bone mineral accrual which is dependent on a speedy and ongoing recovery. While leptin levels in the substudy tended to respond immediately to current nutritional status, IGF-I serum concentrations corresponded to the individual's age and general outcome of AN.
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Affiliation(s)
- Ulrike ME Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Germany
| | - Simone Schuler
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Würzburg, Germany
| | - Dieter Schlamp
- Heckscher Clinic for Child and Adolescent Psychiatry, Munich, Germany
| | - Peter Schneider
- Clinic for Nuclear Medicine, University of Würzburg, Germany
| | - Claudia Mehler-Wex
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Germany
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