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Cited by 47Eating Disorders and BehaviorsBone health and osteoporosis researchNutrition, Health and Food Behavior

Impact of low‐weight severity and menstrual status on bone in adolescent girls with anorexia nervosa

Open access
Kandemir, Nurgun, Becker, Kendra, Slattery, Meghan, Tulsiani, Shreya, Singhal, Vibha, Thomas, Jennifer J., Coniglio, Kathryn, Lee, Hang +4 more·2017·International Journal of Eating Disorders
DOI 10.1002/eat.22681PMC PMC5386816
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Abstract

Clinicians currently use different low‐weight cut‐offs both to diagnose anorexia nervosa (AN) and to determine AN severity in adolescent girls. The purpose of this study was to evaluate the clinical utility of existing cut‐offs and severity criteria by determining which are most strongly associated with risk for low bone mineral density (BMD). Height adjusted BMD Z scores were calculated for 352 females: 262 with AN and 90 healthy controls (controls) (12–20.5 years), using data from the BMD in Childhood Study, for the lumbar spine, whole body less head, and total hip. For most cut‐offs used to define low weight (5th or 10th BMI percentile, BMI of 17.5 or 18.5, and 85 or 90% of median BMI), AN had lower BMD Z scores than controls. AN at >85 or >90% expected body weight for height (EBW‐Ht) did not differ in BMD Z scores from controls, but differed significantly from AN at ≤85 or ≤90% EBW‐Ht. Among AN, any amenorrhea was associated with lower BMD. AN had lower BMD than controls across DSM‐5 and The Society for Adolescent Health and Medicine (SAHM) severity categories. The SAHM moderate severity classification was differentiated from the mildly malnourished classification by lower BMD at hip and spine sites. Amenorrhea and %EBW‐Ht ≤ 85 or ≤ 90% are markers of severity of bone loss within AN. Among severity categories, BMI Z scores (SAHM) may have the greatest utility in assessing the degree of malnutrition in adolescent girls that corresponds to lower BMD.

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  • Severe underweight status may have important prognostic implications in terms of increased risk of other health complications, increased mortality risk, and overall poorer outcome in adults.

    “severe underweight status may have important prognostic implications in terms of increased risk of other health complications, increased mortality risk, and overall poorer outcome in adults [77–80]”

    From Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies (2020) · cites this paper as [78]

    The Discussion (Bone Density across AN Severity Categories; page unavailable) links severe underweight in adolescent girls with anorexia nervosa to lower bone density and possible extreme bone loss, supporting the health-complications portion. The Limitations section says the findings may not apply to adults; the paper does not establish increased mortality or an overall poorer outcome in adults. (LLM, conf=0.90)

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Research works printed but not linked: 1

  1. [22]First M Spitzer R Gibbon M Williams J The structured clinical interview for DSM-IV Axis I Disorders, Research Version, Patient Edition, with Psychotic Screen New York State Psychiatric Institute New York 1997

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Authors
Kandemir, N., Becker, K., Slattery, M., Tulsiani, S., Singhal, V., Thomas, J. J., Coniglio, K., Lee, H., Miller, K. K., Eddy, K. T., Klibanski, A., & Misra, M.
Affiliations
  • Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School Boston Massachusetts
  • Harvard University (US)
ORCID
Venue
International Journal of Eating Disorders
Publisher
Wiley
Published
2017-02-02
Volume
50
Issue
4
Pages
359-369
ISSN
  • 0276-3478 (ISSN-L)
  • 1098-108X
DOI
10.1002/eat.22681
PMC
PMC5386816
OpenAlex
W2584719725
Cited by
47
References
30
Citations by year
2026: 2 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 5 · 2020: 5 · 2019: 4 · 2018: 21 · 2017: 2
FWCI
10.83
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • International Journal of Eating Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health (1UL1TR001102‐01, 8 UL1 TR000170‐05, 1 UL1 RR025758‐04, M01‐RR‐01066, 2 R01 DK062249‐07, 5R01 MH083657‐04, 2R01 DK052625‐11, 1R01MH105515‐01, 5R01HD060827‐05, 1 K24HD071843)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords
anorexia nervosa, adolescent girls, osteopenia, bone loss, amenorrhea, menstrual status, BMI cutoffs, malnutrition, osteoporosis risk
MeSH terms
Adolescent, Amenorrhea, Anorexia Nervosa, Body Weight, Child, Female, Humans, Lumbar Vertebrae, Menstruation, Severity of Illness Index, Absorptiometry, Photon, Bone Density, Young Adult

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