Bone in Anorexia

Abstract

Anorexia nervosa is a feeding disorder involving intentional weight loss. Restricted dietary intake leads to disturbed bone metabolism due to various factors, notably endocrine, that affect bone microarchitecture and incur risk of fracture. Mild to moderate anorexia shows a paradoxical increase in bone marrow adipose tissue, whereas severe forms show gelatinous transformation known as serous atrophy of bone marrow (SABM). Imaging assessment of the mineralized and adipose components uses several techniques: dual-energy X-ray absorptiometry, computed tomography, chemical shift magnetic resonance imaging (MRI), and single-voxel MR spectroscopy. SABM induces MRI bone signal disturbances that can be hard to interpret and may hinder visualization of the fracture line.

Keywords

anorexia nervosa - marrow adipose tissue - serous atrophy of bone marrow - osteoporosis - stress fracture

Publication History

Article published online:
25 September 2023

• References

• 1 Balasundaram P, Santhanam P. Eating disorders. StatPearls Publishing; 2022. Accessed April 10, 2023 at: https://www.ncbi.nlm.nih.gov/books/NBK567717/
• 2 Robinson L, Micali N, Misra M. Eating disorders and bone metabolism in women. Curr Opin Pediatr 2017; 29 (04) 488-496
• 3 Legroux-Gérot I, Vignau J, D'Herbomez M. et al. Evaluation of bone loss and its mechanisms in anorexia nervosa. Calcif Tissue Int 2007; 81 (03) 174-182
• 4 Misra M, Aggarwal A, Miller KK. et al. Effects of anorexia nervosa on clinical, hematologic, biochemical, and bone density parameters in community-dwelling adolescent girls. Pediatrics 2004; 114 (06) 1574-1583
• 5 Misra M, Klibanski A. Anorexia nervosa and bone. J Endocrinol 2014; 221 (03) R163-R176
• 6 Schorr M, Klibanski A. Anorexia nervosa and bone. Curr Opin Endocr Metab Res 2018; 3: 74-82
• 7 Paccou J, Penel G, Chauveau C, Cortet B, Hardouin P. Marrow adiposity and bone: review of clinical implications. Bone 2019; 118: 8-15
• 8 Griffith JF, Yeung DK, Ma HT, Leung JC, Kwok TC, Leung PC. Bone marrow fat content in the elderly: a reversal of sex difference seen in younger subjects. J Magn Reson Imaging 2012; 36 (01) 225-230
• 9 Li X, Kuo D, Schafer AL. et al. Quantification of vertebral bone marrow fat content using 3 Tesla MR spectroscopy: reproducibility, vertebral variation, and applications in osteoporosis. J Magn Reson Imaging 2011; 33 (04) 974-979
• 10 Chappard C. Microarchitecture assessment of human trabecular bone: description of methods. [in French]. Med Sci (Paris) 2012; 28 (12) 1111-1115
• 11 Donaldson AA, Feldman HA, O'Donnell JM, Gopalakrishnan G, Gordon CM. Spinal bone texture assessed by trabecular bone score in adolescent girls with anorexia nervosa. J Clin Endocrinol Metab 2015; 100 (09) 3436-3442
• 12 Singhal V, Tulsiani S, Campoverde KJ. et al. Impaired bone strength estimates at the distal tibia and its determinants in adolescents with anorexia nervosa. Bone 2018; 106: 61-68
• 13 Badr S. Quantification in vivo de l'adiposité médullaire chez l'Homme par imagerie par résonance magnétique. Dissertation. Université de Lille, 2019
• 14 Bainbridge A, Bray TJP, Sengupta R, Hall-Craggs MA. Practical approaches to bone marrow fat fraction quantification across magnetic resonance imaging platforms. J Magn Reson Imaging 2020; 52 (01) 298-306
• 15 Molwitz I, Leiderer M, Özden C, Yamamura J. Dual-energy computed tomography for fat quantification in the liver and bone marrow: a literature review. Röfo 2020; 192 (12) 1137-1153
• 16 Fazeli PK, Klibanski A. The paradox of marrow adipose tissue in anorexia nervosa. Bone 2019; 118: 47-52
• 17 Bredella MA, Fazeli PK, Daley SM. et al. Marrow fat composition in anorexia nervosa. Bone 2014; 66: 199-204
• 18 Ecklund K, Vajapeyam S, Mulkern RV. et al. Bone marrow fat content in 70 adolescent girls with anorexia nervosa: magnetic resonance imaging and magnetic resonance spectroscopy assessment. Pediatr Radiol 2017; 47 (08) 952-962
• 19 Kalamar V, Davies A, Wright P, Suresh P. MRI findings seen in serous atrophy of bone marrow. BMJ Case Rep 2021; 14 (10) e243770
• 20 Tins B, Cassar-Pullicino V. Marrow changes in anorexia nervosa masking the presence of stress fractures on MR imaging. Skeletal Radiol 2006; 35 (11) 857-860
• 21 Salomo L, Salomo M, Andersen SA, Kamper AL. How to exhaust your bone marrow. BMJ Case Rep 2013; 2013: Jun21
• 22 Vande Berg BC, Malghem J, Devuyst O, Maldague BE, Lambert MJ. Anorexia nervosa: correlation between MR appearance of bone marrow and severity of disease. Radiology 1994; 193 (03) 859-864
• 23 Boutin RD, White LM, Laor T. et al. MRI findings of serous atrophy of bone marrow and associated complications. Eur Radiol 2015; 25 (09) 2771-2778
• 24 Vande Berg BC, Malghem J, Lecouvet FE, Lambert M, Maldague BE. Distribution of serouslike bone marrow changes in the lower limbs of patients with anorexia nervosa: predominant involvement of the distal extremities. AJR Am J Roentgenol 1996; 166 (03) 621-625
• 25 Shergill KK, Shergill GS, Pillai HJ. Gelatinous transformation of bone marrow: rare or underdiagnosed?. Autops Case Rep 2017; 7 (04) 8-17
• 26 Teboul-Coré S, Rey-Jouvin C, Miquel A. et al. Bone imaging findings in genetic and acquired lipodystrophic syndromes: an imaging study of 24 cases. Skeletal Radiol 2016; 45 (11) 1495-1506
• 27 Nagata JM, Golden NH, Leonard MB, Copelovitch L, Denburg MR. Assessment of sex differences in fracture risk among patients with anorexia nervosa: a population-based cohort study using the Health Improvement Network. J Bone Miner Res 2017; 32 (05) 1082-1089
• 28 Faje AT, Fazeli PK, Miller KK. et al. Fracture risk and areal bone mineral density in adolescent females with anorexia nervosa. Int J Eat Disord 2014; 47 (05) 458-466
• 29 Kasahara K, Mimura T, Moritani S. et al. Subchondral insufficiency fracture of the femoral head in a pregnant woman with pre-existing anorexia nervosa. Tohoku J Exp Med 2018; 245 (01) 1-5
• 30 Dang T, Faje AT, Meenaghan E. et al. Bone marrow adipose tissue is associated with fracture history in anorexia nervosa. Osteoporos Int 2022; 33 (12) 2619-2627