Anorexia nervosa: hypothalamic amenorrhea and bone metabolism
Daniela Laudisio1,2 – , Chiara Graziadio1,2 – , Renata Simona Auriemma1 – , Emanuela Filice1 – , Silvia Savastano1,2 – , Annamaria Colao1,2,3 –
1 – Department of Clinical Medicine and Surgery, Endocrinology Unit, University “Federico II” of Naples, Naples, Italy.
2 – Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Section of Endocrinology, “Federico II” University of Naples, Naples, Italy
3 – Unesco Chair “Health Education and Sustainable Development”, University “Federico II” of Naples, Naples, Italy
Corresponding Author: Daniela Laudisio
Anorexia nervosa is a psychiatric disorder, predominantly affecting adolescent women, and is characterized by a low body weight following a state of self-induced starvation. This disorder is associated with hormonal adaptations that consume energy expenditure to a minimum in a context of low nutrient intake. These adaptations include: functional hypothalamic amenorrhea, resistance to growth hormone, low concentrations of insulin- like growth factor, low concentrations of leptin and hypercortisolemia. Although, these adaptations may be useful for the short-term survival, often, they contribute to morbidity associated with this disorder, and in particular bone loss, which affects 85% of women with anorexia nervosa. In fact, this category of patients, often demonstrates low bone mineral density and high fractures risk, with low body weight and low gonads being the strongest predictors of observed bone mineral deficiency and fractures risk. Weight restoration and the resumption of menstrual function have the strongest impact on increasing bone mineral density. Other treatment options include bisphosphonates and teriparatide, supported by small clinical trials.
Keywords: nervous anorexia; functional hypothalamic amenorrhea; osteoporosis; bone mineral density; risk of fractures.
Available in LRIOG Nr.1 – 2022