How Does Anorexia Nervosa Affect Your Bone Health

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**Dr. Brent Wells is a graduate of the University of Nevada where he earned his Bachelor of Science degree before moving on to complete his doctorate from Western States Chiropractic College. He is the founder of Better Health Chiropractic & Physical Rehab. He became passionate about being the best Wasilla chiropractor after his own experiences with hurried, unprofessional healthcare providers. The goal for Dr. Wells is to treat his patients with care and compassion while providing them with a better quality of life through his professional treatment.

The relationship between anorexia and bone health is complex. To start, 40% of female anorexia patients have osteoporosis, a bone disease that arises from bone density loss. For anorexic patients, bone health is a major concern for current and future wellness. It is important to understand the full picture of how anorexia weakens bones, who is at risk and what management strategies are effective.

How anorexia weakens bones and leads to osteoporosis

Anorexia is an eating disorder that commonly involves an abnormally low body weight and a fear of gaining weight. Because the body is not getting the normal amount of nutrients, anorexia results in negative impacts on the body. In particular, bone health is a critical area of concern. Anorexia causes nutritional deficiencies, which makes the body run on limited resources. The nutritional deficiencies that anorexia causes may trigger the body to conserve resources for the most critical functions—to keep the heart pumping and blood flowing.

In addition, bone health is extremely important for being able to move normally through life and for supporting the body. Bones need calcium to stay strong, as they are “warehouses” for calcium; in fact, up to 99% of bones are made of calcium. Without the calcium from food intake, the body begins to send the little calcium it receives to maintain blood levels. This means that an individual’s bones do not get the nutrients they need and they start to lose density.

Loss of bone density makes bones less compact and more likely to break. When doctors use a bone mineral density scan, they will see that the bones of anorexic patients may be misshapen, loose material instead of circular, tight, dense material. In fact, bone fractures are extremely common in those with anorexia. In young female patients, the risk of fracture is 1.6 times greater than those without anorexia.

Why young anorexia patients at risk for bone disease

The negative impact of anorexia on bone health is worse if the individual has suffered from a young age. This is due to puberty and adolescence being critical developmental periods. Peak bone mass, which is the maximum amount of bone you will have during your life, is built up during the teenage years. Studies show that for women, 40-60% of bone mass is built from ages 11-14. Unfortunately, anorexia often starts at a young age, which overlaps with this critical bone mass development stage.

Studies show that bone density is lower in young females with anorexia than adults with anorexia, even when they have had the illness for the same amount of time. This suggests that young anorexic patients, especially those between 11-14, are at serious risk for bone disease because they have not yet reached their peak bone mass.

Why young female anorexia patients are at risk for bone disease

With a nutritional deficiency, the body will also conserve resources by shifting nutrients from the reproductive system to areas that are more critical. In other words, the body will undergo not only nutritional deficiencies but also hormonal ones. This presents a problem for bone health for several reasons.

These deficiencies make the body slow down the production of estrogen and other reproductive hormones. This may mean that young women will no longer get their menstrual periods. With low estrogen levels and lack of periods, bone health is affected, as bones are “sensitive to changes in hormone levels.” The lack of estrogen makes bones even weaker.

Studies show that recovering menstrual periods is key to recovering bone health. Experts believe this is true because estrogen is a key component in bone health and because the recovery of menstrual periods also signals that basic nutritional needs are met. The complex relationship between menstrual periods and bone health is shown in a study that used birth control pills to reintroduce normal estrogen levels. This study demonstrated that it is much more effective to restore menstrual periods naturally than to take birth control pills for estrogen.

What bone health management strategies are effective

The main pillar of restoring bone health for anorexia patients is weight restoration, which includes menstrual recovery along with healthy living.

Weight restoration

The nutritional needs for bones involve two main components: calcium and vitamin D. While calcium is the main substance of bones, vitamin D is good for calcium absorption and helps the body retain more calcium. Both of these minerals should be part of a diet program for bone health. For calcium, you can try leafy vegetables, dairy products, and calcium supplements. While calcium supplements are not as good as food sources, they are great for meeting your calcium minimum on a daily basis. On the other hand, you can get vitamin D from eggs, fish and some dairy products. 

Menstrual recovery

Menstrual periods should return with weight restoration and full nutritional health.

Exercise healthy

Exercise is another key area for bone health management. This can be a tricky subject for anorexic patients, as excessive exercise should be avoided since it can keep body weight low, prevent menstrual periods from returning, and cause broken bones. Experts call osteoporosis the “silent disease” because often patients do not realize they have weak bones until they break one.

However, exercise makes bones stronger and it is important to get some exercise during the day, such as walking. Doctors can give expert advice on appropriate exercise plans for each patient.

Final takeaway

Anorexia and bone health are closely related. Research shows that nutritional deficiencies can cause bones to lose density and strength. This also negatively affects menstrual periods and estrogen levels in female patients. Due to the severity of eating disorders and the detriment on an individual’s physical health, it’s essential that providers and patients focus on weight restoration and nutritional balance during recovery.

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