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Anorexia nervosa tied to increased fracture risk
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In patients with anorexia nervosa, the risk for fracture is increased in men older than 40 years and in women of all ages compared with people without the eating disorder, study data show.
Jason M. Nagata, MD, MSc, of the department of pediatrics, Stanford University School of Medicine in Palo Alto, California, and colleagues evaluated data from The Health Improvement Network (THIN) U.K.-based database on 9,239 women and 556 men with anorexia nervosa and 97,889 randomly selected sex-, age- and practice-matched controls without eating disorders to determine sex differences in fracture risk and site-specific fracture incidence in anorexia. At the start of observation, median age was 29.8 years in women and 30.2 years in men. The median observation period was 3.4 years in participants with anorexia nervosa and 3.7 years in controls.
Through observation, 507 incident fractures occurred in participants with anorexia (112 per 10,000 person-years) compared with 3,455 in controls (73 per 10,000 person-years). Median time to fracture from the first code diagnosis for anorexia nervosa was 12.2 years.
Women with anorexia had a higher risk for fracture compared with women in the control group regardless of age (HR = 1.59; 95% CI, 1.45-1.75). Compared with men in the control group, men older than 40 years with anorexia had a significantly higher risk for fracture (HR = 2.54; 95% CI, 1.32-4.9); the increased risk was not observed in men aged 40 years or younger with anorexia.
After adjustment for antidepressant use and alcohol abuse, women with anorexia had a significantly increased risk for fracture at ages older than 40 years (HR = 1.31; 95% CI, 1.1-1.56) and 40 years or younger (HR = 1.49; 95% CI, 1.32-1.68) compared with women in the control group.
The risk for fracture at nearly all anatomic sites was found among women with anorexia compared with women in the control group, with the greatest excess risk at the hip/femur (HR = 5.59; 95% CI, 3.44-9.09) and pelvis (HR = 4.54; 95% CI, 2.42-8.5). The risk for vertebral fractures was significantly increased among men with anorexia compared with men in the control group (HR = 7.25; 95% CI, 1.21-43.45).
“[Anorexia nervosa] and fractures remain formidable health problems with broad public health implications worldwide. ... We found that males with [anorexia nervosa] had an increased risk of fractures at the vertebra and that males over 40 years of age with [anorexia nervosa] had an increased overall fracture risk compared to males without an eating disorder,” the researchers wrote. “Females with [anorexia nervosa] had increased fracture risk across all ages and nearly all anatomic sites with a more than fourfold higher risk at the hip/femur and pelvis. Sex differences in fracture risk among adolescents with [anorexia nervosa] may be behaviorally mediated.” – by Amber Cox
Disclosure: Nagata reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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