Trabecular bone scores reveal weaker bone structure in girls with anorexia nervosa
Trabecular bone score derived from DXA measurements revealed evidence of degraded bone structure in adolescent girls with anorexia nervosa, according to research in The Journal of Clinical Endocrinology & Metabolism.
In a study evaluating bone health among adolescent girls with anorexia nervosa participating in an eating disorders program, researchers found a significant number of participants showed evidence of degraded or partially degraded bone microarchitecture, as well as a correlation between lumbar spine trabecular bone score (TBS) and bone mineral density at the lumbar spine, hip and whole body BMD, as well as accompanying z scores at all sites.
“Our data should raise concern among eating disorder providers, as we showed over 40% of subjects to have evidence of degraded bone microarchitecture,” Catherine M. Gordon, MD, MSc, director of the division of adolescent medicine at Hasbro Children’s Hospital and vice chair for clinical research at the Alpert Medical School at Brown University, told Endocrine Today. “Previous studies of adults have shown an association between TBS and fracture rate. We did not observe this association, but are aware that the fracture rate for children and adolescents is less than that among older adults, the population in which TBS has been most extensively studied. The current TBS data nonetheless heighten concern about bone health in adolescents with eating disorders.”
Catherine M. Gordon
Gordon, Abigail A. Donaldson, MD, and colleagues analyzed data from 57 girls with anorexia nervosa aged 11 to 18 years (mean age, 15.5 years). Researchers used DXA for areal BMD spinal measurements, which were analyzed for TBS, and BMD z score. Researchers compared the findings with clinical and self-reported data, as well as peripheral quantitative computed tomography (pQCT) measurements of the 3%, 38% and 66% regions of the left tibia.
Within the cohort, 6 participants (11%) showed degraded microarchitecture and 19 participants (33%) showed partially degraded microarchitecture. Researchers found that spinal TBS was correlated with age, height, weight, BMI, pubertal stage, BMD and body composition by DXA, and BMD and stress-strain index by pQCT.
“In contrast to the current findings among adolescents, previous studies in adults have not consistently yielded a correlation between TBS and measures of areal BMD,” the researchers wrote. “The current study found these measures to be strongly and significantly correlated.”
The study, Gordon said, is the first to evaluate bone health in a pediatric population. Clinical applications are limited, Gordon added, until reference data for TBS are established for children and adolescents.
“Our hope is that the publication of findings from this exploratory study will stimulate further research in this area,” Gordon said. “Future studies should also explore similar measures of bone health among male, as well as female patients, given the rising prevalence of disordered eating among adolescent boys.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.