Endocrine Abstracts

Osteoporosis is estimated to effect more than 3 million people in UK and secondary osteoporosis accounts for about 30% of women and 55% of men with vertebral fractures. There are many causes of secondary osteoporosis, such as endocrine, gastrointestinal disorders, steroid use, as well as immobility, obesity, bulimia and anorexia nervosa. We present a case of Osteoporosis secondary to anorexia nervosa.77 year”s old lady initially referred to bone clinic at the age of 46 with vertebral fractures with evidence of osteoporosis on DXA scan. Initially managed with IV pamidronate, vertebroplasty and lidocaine injections at painful sites. With no significant improvement in bone DXA scan, she was commenced on trial for teriparatide with some improvement but with considerable side effects (nausea) which was eventually stopped after 18 months. With further decline in bone density, she was initiated on Strontium Ranelate and raloxifene, IV zoledronic acid and eventually currently on subcutaneous denosumab. During this time, she also sustained variable vertebral fractures and limited mobility due to back pain. Most recent DXA Scan showed a T score in the spine of -5.2 and a Z score of -3.4, this is a loss of 4% bone density since her last scan in August 2017, there was a T score in the hip of -3.3 and a Z score of -1.7, this is an increase of 2.4% since her last scan. She has previously been supported with dietician and psychological support with regards to her anorexia nervosa, but she is still struggling with maintaining healthy weight of 36 kg.

Conclusion: Secondary osteoporosis due to Anorexia nervosa can prove to both challenging with treatment options and the individuals needs of the patient. There are limited resources such as the eating disorder service, the patients have a poor body image due to the height loss, which in turn leads to feeling full easily as the organs are restricted. Difficulty in carrying out daily household tasks and the guilt associated with it being self-inflicted.

Low oestrogen in anorexia nervosa secondary to hypothalamic dysfunction can lead to bone loss. Healthy weight gain is the most important aspect of management with multidisciplinary approach involving psychologist, dietician and endocrine team.