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Posted on 10/28/2003 6:36:32 PM PST by Normally a Lurker
Even years after a person is diagnosed with anorexia nervosa, they have twice the risk of bone fractures as their peers without the eating disorder, new study findings from Denmark show.
The findings suggest that damage caused to bones by eating disorders may be permanent, according to a report in the International Journal of Eating Disorders.
However, it is possible that patients in the study were still struggling with the eating disorder, which may have kept bones from regaining strength, the report indicates.
Previous studies have found that people with eating disorders such as anorexia or bulimia can suffer from weakened bones because of poor nutrition. Experts say that this can increase the risk of osteoporosis and fracture.
In the current investigation, Peter Vestergaard of the Aarhus University Hospital in Denmark and colleagues looked at 2,149 people diagnosed with anorexia nervosa, 1,294 people with bulimia nervosa and 942 people with another type of eating disorder. All of the patients - more than 90% female - were compared to a group of over 4,000 healthy people.
Compared to those without an eating disorder, patients were about twice as likely to break a bone after their diagnosis and the risk remained elevated for up to 10 years after diagnosis. The fracture risk was also elevated in those with other eating disorders, but not as dramatically as in patients with anorexia.
The researchers believe anorexia may cause permanent damage to the skeleton, which is later compounded by the loss of bone that can occur with aging. On the other hand, the researchers point out that even after diagnosis and treatment, the eating disorder may not have been completely reversed, resulting in continued nutritional deficits and further decreases in bone mass.
"In conclusion," the authors write, "an increased risk of fractures is present many years after diagnosis of anorexia nervosa, and the group of other eating disorders. These findings call for more awareness of potential skeletal complications linked to eating disorders in general."
One of the most serious effects of anorexia are hormonal changes, which can have severe health consequences:
· Reproductive hormones, including estrogen and dehydroepiandrosterone (DHEA), are lower. Estrogen is important for healthy hearts and bones. DHEA, a weak male hormone, may also be important for bone health and for other functions. ·
· Thyroid hormones are lower. ·
· Stress hormones are higher. ·
· Growth hormones are lower. Children and adolescents with anorexia may experience retarded growth. ·
The result of many of these hormonal abnormalities in women is long-term, irregular or absent menstruation (amenorrhea). This can occur early on in anorexia, even before severe weight loss. Over time this causes infertility, bone loss, and other problems. Low weight alone may not be sufficient to cause amenorrhea. Extreme fasting and purging behaviors may play an even stronger role in hormonal disturbance.
Psychologic Effects and Suicide Adolescents with eating behaviors associated with anorexia (fasting, frequent exercise to lose weight, and self-induced vomiting) are at high risk for anxiety and depression in young adulthood. Some studies estimate that between 12% and 18% of people who are anorexic also abuse alcohol or drugs. Even worse, suicide has been estimated to account for as many as half the deaths in anorexia. In one study, suicide rates occurred in 1.4% of women with anorexia. The study, however, only looked at female death records. Such records may not have always recorded anorexia as an accompanying condition, so the incidence of suicide in anorexia may be much higher.
Heart Disease Heart disease is the most common medical cause of death in people with severe anorexia. The effects of anorexia on the heart are as follows:
· Dangerous heart rhythms, including slow rhythms known as bradycardia, may develop. Such abnormalities can show up even in teenagers with anorexia. ·
· Blood flow is reduced. ·
· Blood pressure may drop. ·
· The heart muscles starve, losing size. ·
· Cholesterol levels tend to rise. ·
A primary danger to the heart is from abnormalities in the balance of minerals, such as potassium, calcium, magnesium, and phosphate, which are normally dissolved in the body's fluid. The dehydration and starvation that occurs with anorexia can reduce fluid and mineral levels and produce a condition known as electrolyte imbalance. Electrolytes (e.g., calcium and potassium) are critical for maintaining the electric currents necessary for a normal heartbeat. An imbalance in these electrolytes can be very serious and even life threatening unless fluids and minerals are replaced. Heart problems are a particular risk when anorexia is compounded by bulimia and the use of ipecac, a drug that causes vomiting.
Long-Term Outlook on Fertility After treatment and an increase in weight, estrogen levels are usually restored and periods resume. In severe anorexia, however, even after treatment, normal menstruation never returns in 25% of such patients.
· If a woman with anorexia becomes pregnant before regaining normal weight, she faces a higher risk for miscarriage, cesarean section, and for having an infant with low birth weight or birth defects. She is also at higher risk for postpartum depression. ·
· Women with anorexia who seek fertility treatments have lower chances for success. ·
Long-Term Effect on Bones and Growth
Almost 90% of women with anorexia experience osteopenia (loss of bone minerals) and 40% have osteoporosis (more advanced loss of bone density). Up to two-thirds of children and adolescent girls with anorexia fail to develop strong bones during their critical growing period. Boys with anorexia also suffer from stunted growth. The less the patient weighs, the more severe the bone loss. Women with anorexia who also binge-purge face an even higher risk for bone loss.
Bone loss in women is mainly due to low estrogen levels that occur with anorexia. Other biologic factors in anorexia also may contribute to bone loss, including high levels of stress hormones (which impair bone growth) and low levels of calcium, certain growth factors, and DHEA (a weak male hormone).Weight gain, unfortunately, does not completely restore bone. Only achieving regular menstruation as soon as possible can protect against permanent bone loss. The longer the eating disorder persists the more likely the bone loss will be permanent.
Testosterone levels decline in boys as they lose weight, which also can affect their bone density. In young boys with anorexia, weight restoration produces some catch-up growth, but it may not produce full growth.
Neurological Problems People with severe anorexia may suffer nerve damage that affects the brain and other parts of the body. The following nerve-related conditions have been reported:
· Seizures. ·
· Disordered thinking. ·
· Numbness or odd nerve sensations in the hands or feet (a condition called peripheral neuropathy). ·
Brains scans indicate that parts of the brain undergo structural changes and abnormal activity during anorexic states. Some of these changes return to normal after weight gain, but there is evidence that some damage may be permanent. Still, the extent of the neurologic problems is unclear, and some studies have been unable to determine specific mental problems associated with anorexia.
Blood Problems
Anemia is a common result of anorexia and starvation. A particularly serious blood problem is pernicious anemia, which can be caused by severely low levels of vitamin B12. If anorexia becomes extreme, the bone marrow dramatically reduces its production of blood cells, a life-threatening condition called pancytopenia.
Gastrointestinal Problems
Bloating and constipation are both very common problems in people with anorexia.
Multiorgan Failure
In very late anorexia, the organs simply fail. The main signal for this is elevated levels of liver enzymes, which require immediate administration of calories.
Complications in Diabetic Adolescents
Eating disorders are very serious for young people with type 1 diabetes. The complications of anorexia that affect all patients are even more dangerous in this group of patients. Hypoglycemia, or low blood sugar, for example, is a danger for anyone with anorexia, but it is a particularly dangerous risk for those with diabetes. One study found that 85% of young women with diabetes and eating disorders had retinopathy, damage to the retina in the eye, which can lead to blindness.
Well that is why you posted this, isn't it??
She started this eating disorder when she was 15?
Is there documentation of this?
Because I've seen her wedding pictures and she doesn't look like she had an eating disorder then
That's true .. good point
Plus there would be medical records
Many elderly people, with no bone problem from bulimia, experience bone fractures while in nursing homes (my Mother being one, BTW).
True .. but if I recall the therapist ordered the scan because Terry showed signs of complaints
However in the report they state there is a history of fractures
Meaning that they were not new
Plus .. if she is so prove to bone fractures .. why hasn't she had more fracturs since that scan was done?
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See the St. Pete Times article I posted a few days ago.
A Battle Over a Life, so Fraught With Irony. at this link
Geez = read the articles.
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