Anorexia nervosa is an eating disorder characterized by:

• great weight loss with a value of Body Mass Index <17.5 FT (18.5-25)
• amenorrhea (at least 3 discharges)
• distorted body image with the feeling that there is excess fat even when the body is bony
• Depressed mood, insomnia, irritability, decreased sexual desire, dry skin.

Anorexia nervosa is a disease that affects the function of many organs and tissues of the human body including bones. Although it affects both sexes, it is 10 times more common in women compared to men and usually the onset of the disease begins at the age of 16-17 years.

The reasons that this disease has a detrimental effect on the skeleton are:

Hormones: In girls, the lack of estrogen that characterizes the disease and causes menstrual disorders has a negative effect on bone growth, especially during adolescence, resulting in low bone density and endurance. Similarly, low testosterone levels negatively affect boys’ bone health. There are also low levels of insulin-like growth factor, a hormone that is important for growth and its reduction has a negative effect on skeletal growth as well as hypercortisolemia, another hormone that has a negative effect on bone metabolism.

• Low body weight: Low weight has an immediate detrimental effect on bones and is an important factor in osteoporosis and increased risk of fracture even for people without anorexia nervosa.
• Poor diet: Due to limited food prevention, people with anorexia nervosa do not receive the proper nutrients necessary for the skeleton (Calcium, Vitamin D, protein, and other important minerals and trace elements).

Treatment

Early diagnosis is important because the loss of bone density can occur very early in the course of the disease.

• The necessary examinations include the measurement of bone density in the context of the investigation of the disease with special attention to its interpretation when it comes to developing skeleton.

Restoring body weight and hormones to normal levels is the cornerstone of treating anorexia nervosa.

A balanced diet rich in calcium, vitamin D, protein and other trace elements is recommended.

• Adopting a healthy lifestyle by avoiding smoking and alcohol will help a lot.
• Although exercise is necessary for the skeleton it needs to be done prudently, in order to avoid physical exertion that can lead to opposite results.
• Currently there are no approved drugs to treat osteoporosis, especially in anorexia nervosa but there are ongoing studies.
• Hormone administration is generally not recommended, although studies with transdermal estrogen during adolescence show that they return their levels to normal.

Advises Mr. George Trovas, Endocrinologist, Laboratory of Research of Musculoskeletal Diseases “Th. Garofalidis”