Osteoporosis

About one in three women and one in ten men will suffer from osteoporosis (thinning bones)during their lifetime. It is most common in older women after the menopause. However people with anorexia and to a lesser extent bulimia, have a much higher risk of developing osteoporosis.

Considerable research has been undertaken on the development of osteoporosis in women with and without an eating disorder. Although much less research has been conducted on males, many experts believe the disease follows much the same pattern although loss of bone density tends to be slower. As yet though there is no proper understanding of the relationship between male hormones and the development of osteoporosis in men with anorexia.

The Causes

The root cause of osteoporosis is not absolutely certain, however one of the prime reasons may be insufficient calcium (from cheese and milk) in the diet. Another reason is a lack of the hormone oestrogen, which slows down the ability of the body to absorb calcium. Amenorrhoea (the absence of ‘periods’), one of the key symptoms of anorexia, is most commonly caused by lack of oestrogen. Having an oopherectomy (removal of the ovaries) will also cause a lack of oestrogen. There are some other factors under investigation, but one key issue is that bones do respond to being under load and exercised or used. A very low body weight may not load the skeletal frame sufficiently to encourage sufficient bone development. However over exercising can also cause oestrogen levels to drop and may lead to increased risks of fractures.

Diagnosis

Osteoporosis is a difficult disease to diagnose, the main indicators that there may be a problem are severe back pain, a loss of height, and curvature of the spine (called kyphosis) all caused by osteoporotic fractures as well as other bone fractures following minor accidents. Low levels of oestrogen could also indicate the possibility of osteoporosis. The diagnosis will normally be confirmed by blood test for oestrogen levels and a bone scan (actually a Dual Energy X-ray Absorptiometry or DEXA scan). You may find the prospect of a scan and then possibly having a problem confirmed rather traumatic, if so, do talk to your doctor about it beforehand.

If you have any concerns about osteoporosis you should always discuss them with your doctor. There are few things that you can do without medical assistance but Vitamin D and calcium supplements may be helpful. Recent research indicates that a high protein intake can heal osteoporosis. Smoking, and a high salt or caffeine intake should all be avoided as these will stop bone building cells working properly.

Treatment

The greatest concern is for girls who develop anorexia before their monthly ‘periods’ start (doctors call this ‘Premenarchal’). There is a risk of stunted growth and irreversible osteoporosis. Treatment with hormones such as oestrogen is not normally advised as it may cause bones to fuse together. This means good nutrition and healthy weight gain in order to restart periods are vitally important. Women whose periods have started (‘Postmenarchal’) who have had anorexia for less than three years, have a very good chance of recovery from osteoporosis if they have calcium and vitamin supplements and gain some weight. A longer period of anorexia up to ten years can make recovery more difficult but not impossible. Full recovery will depend on a number of factors and any other medical problems present.

Women who have had anorexia for over ten years are less likely to recover fully. The most likely treatment is oestrogen replacement (Hormone Replacement Therapy). However the effectiveness of this treatment has yet to be confirmed by long term trials.

Useful Links

The National Osteoporosis Society
PO Box 10, Radstock, Bath, BA3 3YB
Helpline: 01761 472721
Office: 01761 471771