OUTCOME OF BONE-MINERAL DENSITY IN ANOREXIA-NERVOSA PATIENTS 11.7 YEARS AFTER 1ST ADMISSION

Osteopenia is a typical finding in patients suffering from anorexia ne rvosa. Unfortunately, available longitudinal studies are limited by a relatively short follow-up period. Therefore cross-sectional long-term follow-up studies may help to determine both the outcome of this bone lesion and variables that influence its subsequent development. Of an initial 66 consecutive patients with anorexia nervosa, 51 (77.3%) cou ld be further evaluated. After an average of 11.7 years following firs t admission, cross-sectional measurements of lumbar and proximal radia l bone mineral density (BMD) were performed. The ability to predict BM D using variables obtained from anamnestic and clinical data was then determined by multiple-regression analysis. The BMD of both radial and lumbar bone in anorexic patients with poor disease outcome (as define d by the Morgan-Russell general outcome categories) deviated by -2.18 and -1.73 SD (Z score), respectively. In patients with a good disease outcome lumbar BMD was significantly less reduced compared with radial BMD (-0.26 versus -0.68 SD). Variables reflecting estrogen deficiency and nutritional status in the course of the disease, that is, relativ e estrogen exposure (for lumbar BMD) and years of anorexia nervosa (fo r radial BMD), allowed the best prediction of BMD. A marked reduction in cortical and trabecular BMD in anorexic patients with poor disease outcome suggests a higher risk of fractures in these patients. Further more, the finding of a persistently reduced cortical and a slightly re duced trabecular BMD, even in patients with good disease outcome, sugg ests that a recovery of trabecular BMD might be possible, at least in part. Recovery of cortical bone, if possible at all, seems to proceed more slowly.