ARTICLES
Bone Mineral Density in Male Adolescents With Anorexia Nervosa

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ABSTRACT

Objectives

To determine the percentage of male adolescent patients with abnormal bone mineral density (BMD), to identify the variables related to BMD loss, and to study BMD change after follow-up.

Method

Dual-energy–x-ray absorptiometry tests at the lumbar spine (L2–L4) and the femoral neck were administered in 20 male adolescents with anorexia nervosa (treated from 1997 until 2000 at the Department of Child and Adolescent Psychiatry and Psychology of the Hospital Clínic Universitari in Barcelona). Examinations were repeated in 15 patients after a follow-up of 6 to 24 months.

Results

Thirty-five percent of patients had osteopenia at the lumbar spine and femoral neck. The following variables were related to osteopenia: >12 months’ duration of anorexia (p = .003), <3 hours/week of physical activity (p = .009), and calcium intake <600 mg/day (p = .015). In a stepwise logistic regression analysis to predict spinal BMD with the three variables mentioned above, only months of duration entered in the equation (β = 3.5, SE = 1.3, p = .008) and correctly classified 85% of patients. At the follow-up, patients with only partial weight recovery had a BMD loss of 3.2% at lumbar spine and 6.4% at femoral neck, whereas patients with total weight recovery had an increase of 7.8% at lumbar spine and 6.7% at femoral neck.

Conclusions

The risk of osteopenia in male adolescents with anorexia of more than 12 months’ duration is high. In patients with total weight recovery, BMD increase is higher than normal.

Section snippets

Subjects and Procedures

The sample comprised 20 male adolescents aged between 12 and 17 years who met the DSM-IV diagnostic criteria (American Psychiatric Association, 1994) for anorexia nervosa. All patients were attended at the Reference Unit for Eating Disorders of the Department of Child and Adolescent Psychiatry and Psychology of the Hospital Clinic Universitari in Barcelona between 1997 and 2000. Patients in this unit can be treated as inpatients, as outpatients, or as day hospital attenders, and the severity of

General Characteristics

The mean age of anorexic patients at the first consultation was 15.4 years (SD = 1.4). Mean body mass index was 16.2 (SD = 1.2) and mean percentage of weight loss was 21.5% (SD = 4.7). Mean period between the onset of the disorder (i.e., since the first weight loss) and first contact with the team was 12.5 months (SD = 6.4). Mean testosterone value was 392.0 ng/dL (SD = 274.4); alkaline phosphatase, 252.6 U/L (SD = 149.8); and IGF-I, 307.6 ng/mL (SD = 166.3). All patients were restrictive type.

DISCUSSION

The first conclusion of this study was that the percentage of male adolescents with anorexia nervosa with reduced BMD was comparable with the figures recorded for female adolescent patients. As in the case of female adolescent patients, BMD in male adolescent anorexic patients may be within the normal range, but in approximately 35% the BMD z score at the lumbar spine and at the femoral neck was less than −1, thus compatible with osteopenia. In female adolescent patients the percentage varies

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