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Clinical Chemistry 48: 754-760, 2002;
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(Clinical Chemistry. 2002;48:754-760.)
© 2002 American Association for Clinical Chemistry, Inc.

Changes in Bone Turnover in Patients with Anorexia Nervosa during Eleven Weeks of Inpatient Dietary Treatment

Martina Heer1a, Claudia Mika1,2, Ina Grzella2, Christian Drummer3 and Beate Herpertz-Dahlmann2

1 DLR-Institute of Aerospace Medicine, Space Physiology, 51170 Cologne, Germany.

2 Department of Child and Adolescent Psychiatry and
3 Medical Faculty, Technical University of Aachen, 52074 Aachen, Germany.

aAddress correspondence to this author at: DLR-Institute of Aerospace Medicine, Linder Hoehe, 51170 Cologne, Germany. Fax 49-2203-61159; e-mail martina.heer{at}dlr.de.

Background: Many adolescents with anorexia nervosa suffer from severe osteopenia and osteoporosis. We hypothesized that individualized nutrition therapy may improve bone turnover in anorectic patients.

Methods: We studied 19 female patients [mean age, 14.2 ± 1.4 years; mean body weight, 39.3 ± 5.4 kg; mean body mass index (BMI), 14.2 ± 1.4 kg/m2] with anorexia nervosa (International Classification of Diseases-10: F50.0, F50.1) for a period of 3 months. Nutrition therapy began at the end of the first week and included individualized hypercaloric diets, high calcium intake (2000 mg/day), and administration of vitamin D (400 IU/day). Blood samples were taken at baseline and again in weeks 3, 7, and 11. We measured serum calcium, parathyroid hormone, bone formation and resorption markers, insulin-like growth factor 1 (IGF-1), and leptin.

Results: Mean BMI increased significantly, from 14.2 ± 1.4 to 17.1 ± 0.7 kg/m2 (P = 0.000001), during the course of treatment, whereas serum total calcium and phosphate concentrations remained unchanged. The bone formation markers procollagen-I carboxy-terminal propeptide and bone alkaline phosphatase almost doubled (P = 0.006). Both IGF-1 (P = 0.00001) and leptin (P = 0.000005) increased significantly by week 11. Parallel to this, the serum concentration of C-telopeptide, a bone resorption marker, decreased significantly (P = 0.009).

Conclusions: Nutritional rehabilitation, possibly as a result of increasing IGF-1 and leptin concentrations, may increase bone formation. It therefore provides additional objective evidence of the importance of nutrition for bone.




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Open Issues in Anorexia Nervosa: Prevention and Therapy of Bone Loss
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C L Zanker and M P Warren
Regulation of reproductive function in athletic women: an investigation of the roles of energy availability and body composition * Commentary
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M. Heer, C. Mika, I. Grzella, N. Heussen, and B. Herpertz-Dahlmann
Bone turnover during inpatient nutritional therapy and outpatient follow-up in patients with anorexia nervosa compared with that in healthy control subjects
Am. J. Clinical Nutrition, September 1, 2004; 80(3): 774 - 781.
[Abstract] [Full Text] [PDF]


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