February 10, 2014
2 min read

Anorexia nervosa led to significant reductions in areal BMD

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Areal bone mineral density was significantly decreased among patients with anorexia nervosa in a recent study conducted in France.

“In addition to several hormonal factors involved in bone turnover and well known to be altered in [anorexia nervosa] (ie, estradiol, [insulin-like growth factor I], and cortisol), we report for the first time a concomitant variation in sclerostin and [dickkopf-1 protein], two new factors that play a key role in the regulation of osteoblastic function,” researchers wrote.

The researchers conducted the study at the Montpellier University Hospital in France from 2009 to 2012.

Data indicated that areal BMD appeared significantly reduced at all bone sites in 98 patients with anorexia nervosa (mean age, 18.2 years) vs. 63 age-matched controls (range, −3.3% at the radius to −12.1% for total proximal femur).

Serum parathyroid hormone levels were significantly higher (31.8%; P=.02) in patients with anorexia nervosa vs. controls.

Patients with anorexia nervosa also demonstrated lower mean values for markers of bone formation (osteocalcin, –31.7%, P<.001; and procollagen type I N-terminal propeptide, –37.2%, P<.001), and a higher mean value for the marker of bone resorption (type I C-telopeptide breakdown products, 40.4%, P<.001), according to data.

“The reduced bone mass of these patients is unequivocally due to an alteration in osteoblastic function,” researchers wrote. “Among the factors able to alter osteoblastic function, sclerostin and dickkopf-1 protein (DKK-1), both secreted by osteocytes and potent antagonists of the Wnt/beta-catenin pathway, may play a crucial role.”

Sclerostin levels were also significantly greater among patients with the eating disorder (28.2%, P<.001). However, DKK-1 levels were significantly decreased (11.6%, P<.001) compared with controls.

Other biological parameters indicated that the IGF-I levels (–36%, P<.001) and the ratio of IGF-I to insulin-like growth factor-binding protein 3 (IGFBP-3; –37.7%, P<.001) were “dramatically” lower in patients with anorexia nervosa vs. no differences observed in IGFBP-3 when considered alone, researchers wrote.

The duration of the eating disorder, amenorrhea, weight, BMI, fat mass and fat-free soft tissue was negatively correlated with areal BMD. However, the age of onset for anorexia nervosa was positively correlated with areal BMD, according to data. 

“The high levels of sclerostin suggest that sclerostin may be a potential target for therapeutic interventions, and they support the testing for antisclerostin agents as a new pharmacological approach,” researchers wrote.

Disclosure: The researchers report no relevant financial disclosures.