MECHANISMS AND TREATMENT OPTIONS FOR BONE LOSS IN ANOREXIA-NERVOSA

Osteoporosis is present in over half of all patients with anorexia ner vosa. Bone loss often occurs at a young age and may persist even after recovery, predisposing patients to debilitating spinal crush fracture s, The pathogenesis of bone loss in anorexia nervosa is not completely understood and may result from a number of mechanisms, including estr ogen deficiency, inadequate vitamin and calcium intake, and nutritiona l effects on bone formation. Recent studies demonstrate that estrogen itself is inadequate to increase bone density in a majority of patient s with anorexia nervosa and suggest that nutritionally dependent facto rs such as insulin-like growth factor-I (IGF-I), a potent bone trophic hormone, may be important in maintaining bone mass. It is hoped that new anabolic strategies to increase osteoblast function will become av ailable in the future, In the interim, weight gain, restoration of gon adal function, and calcium supplementation remain the cornerstones of treatment in this disease.