Robinson, L. BSc1, Aldridge, V. BSc, MSc, PhD1, Clark, E. BSc,
MB, BS, MSc, PhD, FRCP2, Misra, M. MD, MPH3, Micali, N. MD, MRC
Psych, PhD, FAED1,4.
Purpose This systematic review and meta-analysis investigates
bone mineral density (BMD) in individuals with anorexia nervosa
(AN) and bulimia nervosa (BN) in comparison to healthy controls
(HCs).
Methods • Systematic search using
electronic databases MedLine, EMBASE and PsychInfo and the
Cochrane Library
• Screened 544 articles and included 27 studies in a
random-effects meta-analysis
• AN (n=785), BN (n=187) and HCs (n=1387).
Results BMD was assessed in a total of 2359 participants, of
which 972 had an ED (785 with AN and 187 with BN). All participants
were women. The mean age range was 15.9 – 34.3 years for AN
studies, 22 – 27.7 years for BN studies and 15.1 – 37.4 years for
HCs.
Conclusions This meta-analysis confirms the association between
low BMD and AN, and found that there is also low BMD in BN women of
normal body weight, particularly those with a past history of AN.
Thus, recent weight alone cannot account for low BMD resulting from
an eating disorder. BMD should be assessed not only in patients
with AN, but also in patients with BN. In addition to weight gain,
hormonal and nutritional rehabilitation should be strongly
encouraged.
Figure 1: A PRISMA diagram illustrating the search strategy for
the review
Figure 2: The Standardized Mean Difference in Spinal BMD in AN
vs. Control groups in included
studies
Figure 3: The Standardized Mean Difference in Spinal BMD in BN
vs. Control groups in included studies
Predictors: - Age at Diagnosis - Duration of Diagnosis - BMI -
Duration of amenorrhea Outcome Measures: - Spinal BMD - Hip BMD -
Total BMD - Femoral Neck BMD
Table 1: The results of the meta-analysis
Spine BMD was lowest in AN subjects, but also reduced in BN
subjects. Hip, whole body and femoral neck BMD were reduced in AN
but not BN groups. A past history of AN was strongly predictive of
low BMD in the BN group. The meta-regression was limited by the
number of included studies and did not find any significant
predictors.
Robinson, L., Aldridge, V., Clark, E., Misra, M., Micali, N.
Eating Disorders, Bone Mineral Density and Secondary Osteoporosis:
A Systematic Review and Meta-Analysis. Under Review.
1. Institute of Child Health, University College London, Gower
Street, London, WC1E 6BT, UK 2. Musculoskeletal Research Unit,
University of Bristol, Bristol, UK 3. Neuroendocrine Unit,
Massachusetts General Hospital, Boston, MA 02114, USA 4. Dept. of
Psychiatry, Icahn School of Medicine at Mount Sinai, New York,
US
A Systematic Review and Meta-analysis of the Association between
Eating Disorders and Bone Density
