Elsevier

Mayo Clinic Proceedings

Volume 74, Issue 10, October 1999, Pages 972-977
Mayo Clinic Proceedings

Original Article
Long-term Fracture Risk Among Women With Anorexia Nervosa: A Population-Based Cohort Study

https://doi.org/10.4065/74.10.972Get rights and content

Objectives

To determine if fractures represent an important problem for women with anorexia nervosa who may fail to achieve peak bone mass and may experience premature bone loss from decreased estrogen levels.

Patients and Methods

In this population-based retrospective cohort study, we identified 208 Rochester, Minn, residents that were first diagnosed as having anorexia nervosa between 1935 and 1989, whose subsequent fractures were documented in contemporary medical records and compared with expected numbers of fractures (standardized incidence ratios [SIRs]).

Results

Subjects were followed up for 2689 person-years during which time 45 patients suffered 88 fractures. Fracture risk was increased among the 193 women (SIR, 2.9; 95% confidence interval, 2.0–3.9) as well as the 15 men (SIR, 3.4; 95% confidence interval, 1.1–7.9). The cumulative incidence of any fracture at 40 years after the diagnosis of anorexia nervosa was 57%. Fractures of the hip, spine, and forearm were late complications, occurring on average 38,25, and 24 years, respectively, after diagnosis.

Conclusion

Young women with anorexia nervosa are at increased risk of fractures later in life. Greater attention should be paid to the skeletal health of these individuals.

Section snippets

Patients and Methods

Population-based epidemiological research can be conducted in Rochester because medical records for the entire population are available from almost all providers of care. Mayo Clinic Rochester, for example, has maintained a common medical record with its 2 large affiliated hospitals (Saint Marys and Rochester Methodist) for more than 90 years. This dossier-type record contains both inpatient and outpatient data, and the diagnoses and surgical procedures recorded in these records are entered

Results

Altogether 208 Rochester residents (193 females and 15 males) first met the criteria for anorexia nervosa in the 55-year study period 1935 to 1989. The patients ranged in age from 10 to 57 years, with a median age at diagnosis of 19 years (mean, 21.5 years). All of the patients were white, reflecting the racial composition of the community (99% white in 1970). Eighty-two patients (39%) were deemed to have definite anorexia nervosa, while the condition was classified as probable in 92 (44%) and

Discussion

Anorexia nervosa consistently has been associated with significantly reduced bone mineral density particularly at the lumbar spine16, 17, 18, 19, 20, 21, 22, 23, 25, 26, 27, 49, 50, 51, 52, 53 but also at the proximal femur16, 23, 26, 27, 53, 54 and distal radius26, 31, 52 among other sites. A persistent reduction in total hip bone density of 1.4 SD27 would be expected to increase overall fracture risk in women by about 2.2-fold,55 but this prediction has not been tested. The present analysis

Acknowledgment

The authors would like to thank Susan Stotz and Kay A. Traverse for their help with data collection and Mary G. Roberts for assistance in preparing the manuscript.

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    This study was supported in part by grants AG04875 and AR30582 from the National Institutes of Health.

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    Copyright © 1999 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.