New CT technology shows anorexia impairs adolescent bone development

Children and teenagers with even mild cases of anorexia exhibit abnormal bone structure, according to a new study in the December issue of Radiology.

“Adolescence is the most critical period for growth of bone mass, and the onset of anorexia interferes with that process,” Miriam A. Bredella, MD, musculoskeletal radiologist at Massachusetts General Hospital and assistant professor of radiology at Harvard Medical School in Boston, said in a press release. “Impairment of bone development may permanently alter bone structure and increase the risk of fractures and osteoporosis in adult life.”

The disorder affects one in 100 adolescent girls, according to the National Women's Health Information Center. Among the many health problems associated with anorexia is bone loss. Typically, radiologists use dual-energy X-ray absorptiometry (DXA) to test bone mineral density in adolescents with anorexia, she said in the press release.

Bredella and colleagues set out to determine if alterations in bone structure occur before significant decreases in bone mineral density become evident.

The researchers used high-resolution, flat-panel volume computed tomography (CT) and DXA to study 10 adolescent girls, aged 13 to 18 years, with mild anorexia and 10 age-matched girls without the disorder.

The new, high-resolution CT exam allowed the researchers to identify differences in bone structure between the patients with anorexia and the healthy controls, whereas bone mineral density measurements obtained using DXA did not, according to the press release.

The results showed that while there was not a significant difference in bone mineral density between the anorexic patients and the healthy control group, there were significant structural differences, indicating that changes in bone structure begin to occur in anorexic patients well before decreases in bone density.

“Our data suggest that reassuring values of bone mineral density obtained using DXA may not reflect the true status of bone structure in this undernourished population,” Bredella said in the press release. “In patients with anorexia, bone structure should be analyzed to detect abnormal bone health. Flat-panel volume CT allows the examination of bone at high resolution with relatively low radiation exposure, making it a suitable technique for evaluation of bone structure in adolescent patients.”

Reference:
Bredella MA, Misra M, Miller KK, et al. Distal radius in adolescent girls with anorexia nervosa: Trabecular structure analysis with very high resolution flat-panel volume CT. Radiology. 2008;249:938-946.