Can anorexia lead to osteoporosis?

Worse than a disease that severely affects the body is without a doubt a disease that affects both mind and body. Anorexia nervosa is one such illness and probably one of the most devastating ones at that. The truth about anorexia is that it’s not a silly fad or phase but, in fact, a serious clinical eating disorder. A condition that, if not treated seriously, can be life-threatening.

Causes and effects of anorexia

According to the National Eating Disorders Association (NEDA), the best-known contributor to the development of anorexia nervosa and bulimia nervosa is body dissatisfaction (Stice, 2002). A sad and shocking statistic shows that 40-60% of girls between the ages of 6-12 years old start to express concerns about their image and particularly, their weight.

This irrational fear of weight gain then leads to a ‘simple diet’ in an attempt to shed a few extra kilos but soon takes a wrong turn that ends up in self-starvation. 35% of ‘normal dieters’ progress to pathological dieting. Of those, 20-25% progress to partial or full-syndrome eating disorders (Shisslak, Crago, & Estes, 1995).

Once a person starts starving themselves, the body doesn’t get the necessary nutrients it needs to function optimally and, slowly but surely, the entire body starts to suffer the consequences.

Anorexia is, unfortunately, an illness with many potential long-term side effects. The first victim is often the bones. Next, it’s the heart, muscles, kidneys, hair and skin, among others. In fact, anorexia is a multi-system disease and rarely is there any part of the body that does not get affected by it.

As the body loses muscle mass, it also loses heart muscle, making the heart smaller and weaker. This results in an abnormally slow heart rate and low blood pressure and increases the risk of heart failure.

Fatigue, fainting, dry skin, and hair loss is also common with anorexia patients and the severe state of dehydration can eventually result in kidney failure.

How anorexia affects the skeletal structure

Since anorexia usually starts in adolescence when young people are supposed to reach their peak bone density, the link between anorexia and suffering from osteoporosis later in life, is a real one. In general, anorexia patients suffer from nutritional and hormonal problems that negatively impact bone density.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, low body weight in females causes them to stop having menstrual periods. The result being that the body stops producing oestrogen which is a crucial bone-protecting hormone. On the other hand, weight loss, restricted dietary intake, and testosterone deficiency may be responsible for the low bone density found in males with anorexia.

Individuals with anorexia may also produce excessive amounts of cortisol (the adrenal hormone), which is said to trigger bone loss.

This means that osteoporosis is no longer only considered a disease common with ageing people but can affect anyone, even young people.

Osteoporosis is also known as the “silent epidemic” due to the lack of visible symptoms. This means that bone loss can progress for many years without any prominent symptoms until a bone fractures. If someone suffers from anorexia in their teenage years they may recover from it, but the impact on their skeletal structure might unfortunately not be 100% irreversible.

The good news

The good news is that prevention and treatment are possible. The sooner anorexia is identified – especially in adolescents – the easier it is to prevent its long-term effects on the body.

Medical help is advised for individuals with anorexia mainly to ensure an increase weight gain.

Individuals with anorexia should prioritise their nutrition and are advised to follow a well-balanced diet rich in calcium and vitamin D to ensure healthy bones.

Regular exercise, especially weight-bearing exercises that force you to work against gravity, is great for making bones stronger. Other ways to protect the bones are to avoid smoking which is not only bad for the bones, but also for the heart and lungs; to take hormone replacement medications; or to start with osteoporosis prevention and treatment medications.

NOFSA (National Osteoporosis Foundation South Africa)

NOFSA is the only nonprofit, voluntary health organisation dedicated to promoting lifelong bone health. We focus on reducing the widespread prevalence of osteoporosis while working to find a cure for the disease, and by supporting research and developing programmes of education and advocacy.

Find out more about our work at: www.osteoporosis.org.za

Resources:

1. National Eating Disorders Association

2. National Institute of Arthritis and Musculoskeletal and Skin Diseases