Associations between bone mineral density, body composition and amenorrhoea in females with eating disorders: a systematic review and meta-analysis.

BACKGROUND: Lower bone mineral density (BMD) increases the risk of osteoporosis in individuals with eating disorders (EDs), particularly women with anorexia nervosa (AN), making them susceptible to pain and fractures throughout adulthood. In AN, low weight, hypothalamic amenorrhoea, and longer illness duration are established risk factors for low BMD, and in people with other EDs a history of AN seems to be an important risk factor for low BMD. PURPOSE: To conduct a systematic review and meta-analysis of BMD in individuals with EDs, including AN, bulimia nervosa (BN), binge-eating disorder (BED) and other specified feeding or eating disorders (OSFED) compared to healthy controls (HC). METHODS: Following PRISMA guidelines, electronic databases were reviewed and supplemented with a literature search until 2/2022 of publications measuring BMD (dual-energy X-ray absorptiometry or dual photon absorptiometry) in females with any current ED diagnosis and a HC group. Primary outcomes were spine, hip, femur and total body BMD. Explanatory variables were fat mass, lean mass and ED clinical characteristics (age, illness duration, body mass index (BMI), amenorrhoea occurrence and duration, and oral contraceptives use). RESULTS: Forty-three studies were identified (N = 4163 women, mean age 23.4 years, min: 14.0, max: 37.4). No study with individuals with BED met the inclusion criteria. BMD in individuals with AN (total body, spine, hip, and femur), with BN (total body and spine) and with OSFED (spine) was lower than in HC. Meta-regression analyses of women with any ED (AN, BN or OSFED) (N = 2058) showed low BMI, low fat mass, low lean mass and being amenorrhoeic significantly associated with lower total body and spine BMD. In AN, only low fat mass was significantly associated with low total body BMD. CONCLUSION: Predictors of low BMD were low BMI, low fat mass, low lean mass and amenorrhoea, but not age or illness duration. In people with EDs, body composition measurement and menstrual status, in addition to BMI, are likely to provide a more accurate assessment of individual risk to low BMD and osteoporosis.

Individuals with eating disorders (EDs) have an increased risk for developing osteoporosis and suffering fractures. To better understand this problem, we conducted a systematic review and meta-analysis comparing bone mineral density (BMD) of females with EDs with that of healthy people without an ED. We also tried to identify key factors linked with reduced bone mass in EDs. We included studies reporting BMD of individuals with anorexia nervosa (AN), bulimia nervosa (BN), binge-eating (BED) or other non-specified ED (OSFED), and of healthy controls. We found that people with AN had overall lower BMD than controls and also in the spine, hip, and femur. In people with BN, there was lower BMD overall and in the spine, but that must be only in those who previously had AN. In people with OSFED, BMD was lower in the spine. Having a low BMI, low fat mass, low lean mass and not having menstrual periods seem to negatively affect BMD. Therefore, this systematic review supports the idea that people with current or past AN, irrespective of their current ED diagnosis, should have their bone health assessed. For early identification of those most at risk, body composition measurements, current menstrual status, duration of amenorrhoea and presence or absence of a history of AN should be considered in clinical practice.

High parathyroid hormone levels are associated with poor balance in older persons: A cross-sectional study.

OBJECTIVES: A high level of parathyroid hormone (PTH) was recently identified as a risk factor for falling. As balance instability is one of the major risk factors for falls, we aimed to investigate whether high PTH concentrations are associated with poor balance in older persons. STUDY DESIGN: Cross-sectional study with 127 community-dwelling older adults (75% female), aged 65-96 years, at the Falls and Fracture Clinic, Western Health-Sunshine Hospital, Melbourne, Australia. Patients with clinical conditions that could affect balance (e.g. Meniere's disease), denosumab users, and those with advanced kidney failure were excluded. MAIN OUTCOME MEASURES: We assessed dynamic balance by timed "up and go" (TUG)and four-square step tests, and by gait parameters; and static balance by posturography on a force platform. Blood tests provided values of PTH, vitamin D, calcium, albumin, and creatinine. Standard questionnaires were applied to assess clinical condition, medications and nutritional status, and to screen for depression. RESULTS: For dynamic balance, elevated PTH concentrations resulted in increased time to complete the TUG test (ß = 0.13; 95%CI: 0.01-0.26), indicating worse performance. For static balance, increased PTH was associated with increased instability in the center of pressure while standing with eyes closed on a hard surface (ß = 0.38; 95%CI: 0.03-0.73). Both models were controlled for vitamin D, renal function, nutritional and depressive status, age, sex, and number of medications. CONCLUSION: Increasing concentrations of PTH in this population of older persons had an independent negative association with both static and dynamic balance, which could place them at risk of falls. However, longitudinal studies are still required.

Densidad ósea elevada y salud ósea / High bone density and bone health

El objetivo de este artículo es revisar los aspectos principales relacionados con la Densidad Ósea Elevada (DOE) y analizar los mecanismos fisiológicos implicados en la salud ósea. No existen aún criterios bien definidos que sirvan para identificar a los individuos con DOE, y los estudios sobre el tema son escasos. La mayoría de los estudios demuestran que el exceso de peso, el sexo masculino, la raza negra, la actividad física, la ingesta de calcio y flúor y el uso de medicamentos como las estatinas y los diuréticos tiazídicos desempeñan un papel relevante y positivo en la Densidad Mineral Ósea (DMO). Además, se ha observado que los individuos con enfermedades tales como obesidad, diabetes, cáncer de mama positivo para receptores de estrógenos o cáncer del endometrio tienen mayor DMO que los individuos sanos; del mimo modo, se observa una mayor DMO en atletas frente a los que no lo son, sin que ello necesariamente sea sinónimo de salud ósea. Un mejor entendimiento de los factores de riesgo y de protección podría ayudar a mejorar el tratamiento de los pacientes con fragilidad ósea e incidir en la prevención de la osteoporosis, especialmente en los factores de riesgo no modificables (AU)

The aim of this paper is to review the main aspects related to high bone density (HBD) as well as to discuss the physiologic mechanisms involved in bone health. There are still no well-defined criteria for identification of individuals with HBD and there are few studies on the topic. Most studies demonstrate that overweight, male gender, black ethnic background, physical activity, calcium and fluoride intake and use of medications such as statins and thiazide diuretics play a relevant and positive role on bone mineral density. Moreover, it is known that individuals with certain diseases such as obesity, diabetes, estrogen receptor-positive breast or endometrial cancer have greater bone density than healthy individuals, as well as athletes having higher bone density than non-athletes does not necessarily mean that they have healthy bones. A better understanding of risk and protective factors may help in the management of patients with bone frailty and have applicability in the treatment and in the prevention of osteoporosis, especially intervening on non-modifiable risk factors (AU)

Relationship between calcium intake and body mass index in adolescents

Epidemiologic and experimental data support the possibility that dietary calcium intake plays a role in human body weight regulation. The aim of the present study was to evaluate calcium intake and its relationship with body mass index (BMI) in adolescents. Weight, height, 3-day food record and a food frequency questionnaire were collected among all adolescents participants at the Outpatient Clinic for Adolescents at the Federal University of Sao Paulo between 2001 and 2003. The statistical analysis comprised Chi-square, Student's T-test, Pearson correlation and linear regression. One-hundred and twenty-one adolescents were studied (62.8 per cent female), with a mean age of 14.9 ±2.2 years old. Mean energy and calcium intakes were 1729.9±557.8 kcal/day and 598.2±287.9 mg/day respectively, with no significant statistical differences between sex or age. Almost ninety-eight percent of adolescents presented a mean calcium intake lower than proposed values. Calcium intake adjusted for energy presented a significant negative correlation with body weight (r=-0.194, p=0.03) and BMI (r=-0.185, p=0.04). Furthermore, adolescents in the lowest quartile of calcium intake presented higher BMI (29.7±7.4 kg/m2) than adolescents in the highest calcium quartile. These results indicated a dietary calcium intake lower than recommendations for this life stage, and a contribution of this mineral in the body mass index