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Dr Michael Cooper
The reproductive endocrine consequences of anorexia nervosa
Mandy G Katz & Beverley Vollenhoven
British Journal of Obstetrics and Gynaecology, June 2000, Vol 107. p707 - 713
This is a most timely review article which emphasizes the very significant long-term problems associated with anorexia nervosa. The condition has been reported over at least the last few hundred years. Menstrual disturbances have long been associated with the disorder and indeed some have suggested that amennorhoea (absent periods) should be included for the diagnosis. The development of osteopenia (weak bones) and osteoporosis is a major concern for individuals with anorexia. The peak incidence of anorexia is during the adolescent years and this is the critical time for bone development as more than half of the bone calcium in an individual is normally laid down during these years. Failure to attain sufficient bone density during this time places these individuals at substantial risk of increased bone fractures later in life. Not surprisingly the younger the individual with anorexia and the longer the duration, the worse the potential outcome. Young women with the disease may lose as much as 2% to 6% of bone mass each year of their disorder. Results from long term follow-up have revealed that these losses in bone density may not be fully reversible even when there is resumption of menses and weight gain.
Treatment should involve measures to ensure adequate nutrition and weight gain and the resumption of menses. Unfortunately it has been recently reported that simple oestrogen replacement, often involving the oral contraceptive pill, has little independent effect in the correction or prevention of osteopenia in anorexia.
The female athletic triad has been described as a syndrome in young active girls and women. The problems include eating disorders, amennorhoea and osteoporosis. Females training in sports that emphasize appearance and a low body weight for athletic performance are highest risk. The repercussions involve a decrease in physical performance and subsequent significant health complications including osteoporosis. Common sense dictates the treatment, which includes early recognition of the problem, decreasing the intensity and frequency of exercise and nutritional counseling.
Anorexia nervosa is undoubtedly a difficult condition to manage with potentially serious consequences. Early diagnosis and immediate medical, nutritional and psychiatric assistance is crucial in preventing long-term complications.
Michael Cooper
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Last updated 18th March, 2001