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Disordered eating increases risk for low BMD in men
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Men with eating disorders are at increased risk for low bone mineral density and estimated hip strength compared with healthy controls, with the highest risk observed for men with anorexia nervosa with low body weight and muscle mass, according to findings published in Clinical Endocrinology.
“Men with anorexia nervosa, atypical anorexia nervosa (who are not low weight despite significant weight loss) and avoidant/restrictive food intake disorder (who have a pattern of avoidant or restrictive eating in the absence of psychological symptoms of anorexia nervosa) are at risk for low BMD,” Melanie Schorr, MD, instructor in medicine at Harvard Medical School and assistant in medicine at Massachusetts General Hospital, Boston, told Endocrine Today. “Men with a long disease duration or who have low weight, muscle mass and/or vitamin D levels may be at particularly high risk for low BMD.”
Schorr and colleagues analyzed data from 103 men, including 26 men with anorexia nervosa (mean age, 31 years), 18 men with atypical anorexia nervosa (mean age, 26 years), 11 men with avoidant/restrictive food intake disorder (mean age, 28 years) and 48 healthy, age- and race-matched controls (mean age, 29 years). Within the cohort, 21 men were admitted between 2009 and 2017 to an inpatient medical stabilization program at the ACUTE Center for Eating Disorders in Denver. All men underwent BMD measurements of the spine, total hip and femoral neck via DXA. Researchers assessed highest and lowest body weight, duration of illness, vitamin D status, hours of physical activity per week and history of fracture. Total daily calcium intake was assessed via a calcium questionnaire.
Researchers found that men with anorexia nervosa and men with avoidant/restrictive food intake disorder had lower mean spine and total hip BMD z scores vs. controls (P < .05), whereas mean femoral neck BMD z scores were lower only for men with anorexia nervosa vs. controls (P < .05). Men with atypical anorexia nervosa had mean BMD z scores similar to controls at all sites, according to researchers.
The prevalence of a BMD z score less than –1 at any site was higher among men with anorexia nervosa vs. controls (81% vs. 31%; P < .0001) but similar among men with avoidant/restrictive food intake disorder (64%) and atypical anorexia nervosa vs. controls (56%). The prevalence of a BMD z score less than –2 at any site was higher among men with anorexia nervosa (65%) and men with atypical anorexia nervosa (33%) vs. controls (6%; P < .01), according to researchers.
Researchers observed linear, univariate associations between current BMI and BMD z scores at all sites, section modulus at all sites and buckling ratio at the intertrochanteric and femoral shaft (P < .0001 for all), as well as linear associations between appendicular lean mass and BMD z scores at all sites, section modulus at all sites and buckling ratio at the intertrochanteric and narrow neck (P < .0002 for all). After adjustment for BMI, the relationship between appendicular lean mass and BMD z score and appendicular lean mass and section modulus persisted (P < .05), according to researchers.
In men with eating disorders, researchers found that illness duration was negatively associated with BMD z scores and section modulus and positively associated with buckling ratio at all sites, with results persisting after adjusting for BMI. Additionally, in men with eating disorders, 25-hydroxyvitamin D level was associated with BMD z score, section modulus and buckling ratio at all sites, with results persisting after adjustment for BMI (P < .05).
“Clinicians should consider screening men with a history of these eating disorders for low BMD,” Schorr said. “Future longitudinal studies that include BMD, endocrine hormone variables and fracture data across the natural history of disease could inform recommendations for BMD screening in men with these eating disorders.” – by Regina Schaffer
For more information:
Melanie Schorr, MD, can be reached at the MGH Neuroendocrine Unit, 55 Fruit St., Bulfinch 457B, Boston, MA 02114; email: mschorr1@partners.org.
Disclosure: Schorr reports no relevant financial disclosures.
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