Bone mineral density, osteoporosis, and fractures among people with eating disorders: a systematic review and meta-analysis

• Published in: Acta psychiatrica Scandinavica Vol. 133; no. 5; pp. 341 - 351
• Main Authors: Solmi, M., Veronese, N., Correll, C. U., Favaro, A., Santonastaso, P., Caregaro, L., Vancampfort, D., Luchini, C., De Hert, M., Stubbs, B.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.05.2016
• Subjects: anorexia nervosa; Bone density; Bone Density - physiology; bulimia nervosa; Comorbidity; Eating disorders; Feeding and Eating Disorders - epidemiology; Fractures; Fractures, Bone - epidemiology; Humans; Osteoporosis; Osteoporosis - epidemiology; Psychiatry; Risk factors; bulimia nervosa; eating disorders; anorexia nervosa; fractures; bone density
• ISSN: 0001-690X; 1600-0447; 1600-0447
• DOI: 10.1111/acps.12556

Objective To provide meta‐analytical evidence of bone mineral density (BMD), fractures, and osteoporosis rates in eating disorders (ED) vs. healthy controls (HCs). Method Three independent authors searched major electronic databases from inception till August 2015 for cross‐sectional studies reporting BMD in people with ED (anorexia nervosa, (AN); bulimia nervosa, (BN); eating disorders not otherwise specified, (EDNOS)) vs. HCs. Standardized mean differences (SMDs) ±95% and confidence intervals (CIs) were calculated for BMD, and odds ratios (ORs) for osteopenia, osteoporosis, and fractures. Results Overall, 57 studies were eligible, including 21 607 participants (ED = 6485, HCs = 15 122). Compared to HC, AN subjects had significantly lower BMD values at lumbar spine (SMD = −1.51, 95% CI = −1.75, −1.27, studies = 42), total hip (SMD = −1.56, 95%CI = −1.84, −1.28, studies = 23), intertrochanteric region (SMD = −1.80, 95%CI = −2.46, −1.14, studies = 7), trochanteric region (SMD = −1.05, 95%CI = −1.44, −0.66, studies = 7), and femoral neck (SMD = −0.98, 95%CI = −1.12, −0.77, studies = 20). Reduced BMD was moderated by ED illness duration and amenorrhea (P < 0.05). AN was associated with an increased likelihood of osteoporosis (OR = 12.59, 95%CI = 3.30–47.9, P < 0.001, studies = 4) and fractures (OR = 1.84, 95% CI = 1.17–2.89, I2 = 56, studies = 6). No difference in BMD was found between BN and EDNOS vs. HC. Conclusion People with AN have reduced BMD, increased odds of osteoporosis and risk of fractures. Proactive monitoring and interventions are required to ameliorate bone loss in AN.