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Peer-reviewedCC BY 4.0Nutrients

Bone Density Measurement in Anorexia Nervosa: A Missed Opportunity

  • Alan Duffy1
  • Dan V. Blalock1,2,3
  • Renee D. Rienecke1,4
  • Thomas Joiner1,5
  • Philip S. Mehler1,6
6 affiliations
  1. 1Eating Recovery Center/Pathlight Mood & Anxiety Centers, 7351 E Lowry Blvd, Denver, CO 80230, USA
  2. 2Durham Veterans Affairs Medical Center, 508 Fulton St, Durham, NC 27705, USA
  3. 3Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 200 Trent Drive, Durham, NC 27710, USA
  4. 4Department of Psychiatry and Behavioral Sciences, Northwestern University, 633 Clark Street, Evanston, IL 60208, USA
  5. 5Department of Psychology, Florida State University, 1879 Miller Landing Rd., Tallahassee, FL 32312, USA
  6. 6Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA
Open at sourceDOICite

Abstract

Background/Objectives: Loss of bone mineral density is a common, serious, and often irreversible complication of anorexia nervosa (AN). However, it can be detected by a simple procedure termed dual-energy X-ray absorptiometry (DXA). Methods: We review adherence to guidelines, which discuss when this test should be obtained, via a retrospective review of 174 participants treated at a residential treatment center. Electronic health records were reviewed to determine the participants’ most recent DXA. Results: Seventy-six people (43.7%) had prior DXAs. Of these, 20 (26.3%) reported their DXAs demonstrated no bone disease. For patients with prior DXA, 48 (63.2%) reported awareness of bone disease, and having any bone disease was significantly more likely than having none (χ2 = 11.53, p < 0.001). Older patients were more likely to have a prior DXA (OR = 1.07, 95% CI [1.04, 1.10], p < 0.001). Ten (13.1%) people under age 25 had bone disease. People with a longer duration of illness were more likely to have a prior DXA (OR = 1.08, 95% CI [1.04, 1.12], p < 0.001). Conclusions: This study demonstrates poor adherence to obtaining DXA testing in AN. This is likely due to “clinical inertia” and lack of clear guidelines, and needs to be addressed to avert long-term adverse sequelae, especially because successful refeeding and weight restoration may not be sufficient to prevent ongoing loss of bone mineral density.

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Cite

BibTeXRIS
BibTeX
@article{duffy2026bone,
  title = {{Bone Density Measurement in Anorexia Nervosa: A Missed Opportunity}},
  author = {Alan Duffy and Dan V. Blalock and Renee D. Rienecke and Thomas Joiner and Philip S. Mehler},
  journal = {Nutrients},
  year = {2026},
  month = oct,
  doi = {10.3390/nu18213617},
  url = {https://www.mdpi.com/2072-6643/18/21/3617},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Bone Density Measurement in Anorexia Nervosa: A Missed Opportunity
AU  - Alan Duffy
AU  - Dan V. Blalock
AU  - Renee D. Rienecke
AU  - Thomas Joiner
AU  - Philip S. Mehler
PY  - 2026
DA  - 2026/10/31
JO  - Nutrients
DO  - 10.3390/nu18213617
UR  - https://www.mdpi.com/2072-6643/18/21/3617
AB  - Background/Objectives: Loss of bone mineral density is a common, serious, and often irreversible complication of anorexia nervosa (AN). However, it can be detected by a simple procedure termed dual-energy X-ray absorptiometry (DXA). Methods: We review adherence to guidelines, which discuss when this test should be obtained, via a retrospective review of 174 participants treated at a residential treatment center. Electronic health records were reviewed to determine the participants’ most recent DXA. Results: Seventy-six people (43.7%) had prior DXAs. Of these, 20 (26.3%) reported their DXAs demonstrated no bone disease. For patients with prior DXA, 48 (63.2%) reported awareness of bone disease, and having any bone disease was significantly more likely than having none (χ2 = 11.53, p < 0.001). Older patients were more likely to have a prior DXA (OR = 1.07, 95% CI [1.04, 1.10], p < 0.001). Ten (13.1%) people under age 25 had bone disease. People with a longer duration of illness were more likely to have a prior DXA (OR = 1.08, 95% CI [1.04, 1.12], p < 0.001). Conclusions: This study demonstrates poor adherence to obtaining DXA testing in AN. This is likely due to “clinical inertia” and lack of clear guidelines, and needs to be addressed to avert long-term adverse sequelae, especially because successful refeeding and weight restoration may not be sufficient to prevent ongoing loss of bone mineral density.
SN  - 2072-6643
ER  -