Bone mineral density, osteoporosis, and fractures among people with eating disorders: a systematic review and meta-analysis
Abstract
OBJECTIVE: To provide meta-analytical evidence of bone mineral density (BMD), fractures, and osteoporosis rates in eating disorders (ED) vs. healthy controls (HCs). METHOD: Three independent authors searched major electronic databases from inception till August 2015 for cross-sectional studies reporting BMD in people with ED (anorexia nervosa, (AN); bulimia nervosa, (BN); eating disorders not otherwise specified, (EDNOS)) vs. HCs. Standardized mean differences (SMDs) ±95% and confidence intervals (CIs) were calculated for BMD, and odds ratios (ORs) for osteopenia, osteoporosis, and fractures. RESULTS: Overall, 57 studies were eligible, including 21 607 participants (ED = 6485, HCs = 15 122). Compared to HC, AN subjects had significantly lower BMD values at lumbar spine (SMD = -1.51, 95% CI = -1.75, -1.27, studies = 42), total hip (SMD = -1.56, 95%CI = -1.84, -1.28, studies = 23), intertrochanteric region (SMD = -1.80, 95%CI = -2.46, -1.14, studies = 7), trochanteric region (SMD = -1.05, 95%CI = -1.44, -0.66, studies = 7), and femoral neck (SMD = -0.98, 95%CI = -1.12, -0.77, studies = 20). Reduced BMD was moderated by ED illness duration and amenorrhea (P < 0.05). AN was associated with an increased likelihood of osteoporosis (OR = 12.59, 95%CI = 3.30-47.9, P < 0.001, studies = 4) and fractures (OR = 1.84, 95% CI = 1.17-2.89, I(2) = 56, studies = 6). No difference in BMD was found between BN and EDNOS vs. HC. CONCLUSION: People with AN have reduced BMD, increased odds of osteoporosis and risk of fractures. Proactive monitoring and interventions are required to ameliorate bone loss in AN.
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In the United States, people with severe mental illness are twice as likely as those without mental disorders to have been denied medical insurance because of a pre-existing condition.
“In the United States, they are twice as likely as those without mental disorders to have been denied medical insurance because of a pre-existing condition.108”
From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [108]
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Ashdown-Franks, G., Firth, J., Carney, R., Carvalho, A. F., Hallgren, M., Koyanagi, A., Rosenbaum, S., Schuch, F. B., Smith, L., Solmi, M., et al. (2020) · Sports Medicine · doi:10.1007/s40279-019-01187-6 · Cited by 446 · see citing works
Self-citationMedical complications of anorexia nervosa and bulimia nervosa
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Solmi, M., Collantoni, E., Meneguzzo, P., Degortes, D., Tenconi, E., & Favaro, A. (2018) · International Journal of Eating Disorders · doi:10.1002/eat.22884 · Cited by 119 · see citing works
Self-citationMedical Management of Eating Disorders: An Update
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Self-citationImpact of low‐weight severity and menstrual status on bone in adolescent girls with anorexia nervosa
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Veronese, N., Stubbs, B., Koyanagi, A., Hébert, J. R., Cooper, C., Caruso, M. G., Guglielmi, G., Reginster, J. Y., Rizzoli, R., Maggi, S., et al. (2018) · Osteoporosis International · doi:10.1007/s00198-017-4251-5 · Cited by 36 · see citing works
Self-citation
- Authors
- Solmi, M., Veronese, N., Correll, C. U., Favaro, A., Santonastaso, P., Caregaro, L., Vancampfort, D., Luchini, C., De Hert, M., & Stubbs, B.
- Affiliations
- University of Padua (IT)
- Northwell Health (US)
- KU Leuven (BE)
- University of Verona (IT)
- Department of Rehabilitation Sciences Leuven – University of Leuven Leuven Belgium
- National Health Service (GB)
- Corresponding author
- Stubbs, B.
- ORCID
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2016-01-13
- Volume
- 133
- Issue
- 5
- Pages
- 341-351
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- OpenAlex
- W2236941060
- Cited by
- 124
- References
- 99
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 13 · 2023: 10 · 2022: 12 · 2021: 19 · 2020: 10 · 2019: 11 · 2018: 16 · 2017: 11 · 2016: 7 · 2015: 2
- FWCI
- 2.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Lirias (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Funders
- Bristol-Myers Squibb
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bone Metabolism and Diseases
- Keywords
- bone mineral density, osteoporosis, fracture, eating disorders, anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, osteopenia, amenorrhea, disease duration, bone health, lumbar spine, hip bone density, femoral neck, intertrochanteric region, trochanteric region, osteoporosis risk factors
- MeSH terms
- Feeding and Eating Disorders, Humans, Osteoporosis, Bone Density, Comorbidity, Fractures, Bone
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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