Osteoporosis in Anorexia nervosa. New aspects of pathogenesis and therapy

Osteoporosis has been shown to be a relatively common complication of anore xia nervosa (ARI). So far the exact mechanisms which are implicated are not fully clarified. Several factors such as malnutrition, reduced body weight , amenorrhea, and hypercortisolaemia seem to be involved. There is a strong relationship with the duration of amenorrhea and - in some studies with th e age of onset. Osteoporosis is for a long time a "silent" disease and the first symptoms such as back pain,loss of height, kyphosis, and fractures ar e late complications. Therefore, routine screening methods for bone density measurements should be established. The most accurate is the dual energy X -ray absorptiometry (DEXA). Therapeutically the primary aim should be to re ach restoration of both normal body weight and regular menses. As AN is a c hronic disease clinicians should be aware of the dangers of osteoporosis an d start with the treatment and/or prevention of osteoporosis early. However , at this stage it is difficult to provide an evidence-based management pla n for osteoporosis in AN. Hormone replacement therapy (HRT) as well as calc ium and vitamine D-supplementation are under discussion, however, further c ontrolled investigations are warranted.