Bone quality assessed by trabecular bone score in severe anorexia nervosa: A brief report

International Journal of Eating Disorders
By Bone quality assessed by trabecular bone score in severe anorexia nervosa: A brief report Philip S. Mehler, MD, FACP, FAED, CEDS Linda Fielding MD

Objective

Low bone mineral density (BMD) in anorexia nervosa (AN) leads to increased risk of fractures. Debate exists whether to medicinally treat young patients with AN based on abnormal dual-energy x-ray absorptiometry (DXA) scores or to weight restore and reassess when older. Trabecular bone score (TBS), a technology measuring bone quality, is used in conjunction with DXA. This report explores the potential additional value of TBS, in adults with severe AN, to augment the DXA diagnostic information.

Method

Seventy-one DXA scans were reanalyzed to obtain TBS results from patients (mean age: 36.3 years). Differences in laboratory, anthropometric values and concomitant DXA measurements in relation to TBS results are reported.

Results

For the cohort, mean body mass index (BMI) was 13.6 kg/m2 (SD: 2.1). The vast majority of patients had normal TBS with a mean of 1.395 (SD: 0.08) but, most patients (69%) had abnormal average DXA BMD Z-scores of -2.2 (SD: 1.2). The patients who also demonstrated degraded bone quality on TBS had significantly lower percent ideal body weight and elevated alkaline phosphatase compared to patients with normal TBS (p's < .05).

Discussion

Low BMD treatment decisions in AN may be optimized by considering both DXA and TBS results.

Keywords

DXA; TBS; anorexia nervosa; bone mineral density; bone quality; trabecular bone score.

DOI:
https://pubmed.ncbi.nlm.nih.gov/33778960/
Written by
Philip S. Mehler, MD, FACP, FAED, CEDS

Philip S. Mehler, MD, FACP, FAED, CEDS

Dr. Mehler founded ACUTE Center for Eating Disorders & Severe Malnutrition in 2001. He began his career at Denver Health more than 35 years ago and was formerly its Chief of Internal Medicine and…

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