De gids voor de geestelijke gezondheidszorg

Osteoporosis and Eating Disorders

Author Lucy Serpell; May 1999

What is Osteoporosis?

Osteoporosis is the medical name for thin bones. Bones are made up of a network of fibres made from calcium and other materials such as collagen. In osteoporosis the fibres get thinner and the holes between them get larger until the bones can fracture and break very easily. Osteoporosis can often be present even though there are no symptoms, so it is difficult to diagnose. However, if it is diagnosed, treatment can be given. The most common symptoms of the disease are loss of height (because of bones in the spine being crushed together), and fractures, especially of the ribs, wrist and hips.

Osteoporosis and Eating Disorders

Recently, doctors have begun to notice that people who have suffered from an eating disorder such as anorexia nervosa (or less commonly bulimia) fracture their bones more than would be expected for their age. This suggests that their bones are thinner or more fragile than people of a similar age who have not suffered from an eating disorder. Sure enough, when doctors looked closely at the bone structure of these patients they found that in some cases, low bone density was causing an increased risk of fractures.

Diagnosing Osteoporosis

If doctors think a patient may have osteoporosis, the most common way of diagnosing this will be by some sort of bone scan. There are various different types of scan, but all do basically the same thing. They scan the bones (most commonly those in the spine and hip) to measure their density. Then these measurements are compared to average bone density values in their age group.
In the last few years, new techniques have been developed to look at how quick bone is being lost and gained. These involve looking at the levels of certain chemicals in a patient's blood and urine which vary depending on the activity of the cells which build bone and which break it down. This sort of information can also help to understand more about how osteoporosis works in Eating Disorders, and will have implications for treatment.


No one is yet sure why people with eating disorders sometimes get osteoporosis. However, two things seem likely to be important.
Firstly, amenorrhoea (loss of periods) is an indication that levels of oestrogen (estrogen) are lower than they should be. Oestrogen is known to affect bone density (which is why women are especially at risk for the disease after the menopause).
Secondly, good nutrition, in particular having enough calcium in the diet, is important for healthy bones as calcium is an important component of the bone matrix. Calcium is present in dairy products like milk, cheese and cream, and also in green vegetables, pasta and bread.


If you have an eating disorder and you are underweight and/or not having regular periods, you may be at risk for osteoporosis. Try to follow these steps to keep your bones healthy:
1. If at all possible, try to eat some CALCIUM RICH FOODS every day. If you try to avoid dairy products because of their fat content, try to find other calcium rich food that you don't mind eating. Broccoli is a particularly good source. Also try yoghurt, skimmed milk and most green vegetables
2. MODERATE exercise is good for your bones if it is 'weight-bearing'. This means aerobics, walking, running and so on rather than swimming or horse-riding. If you have advanced osteoporosis, your doctor may advise you to reduce your level of exercise to avoid fractures
3. MENSTRUATION: If you possibly can, keeping your weight high enough so that you have regular periods should help to protect you against osteoporosis


The commonest treatment for osteoporosis in older women is Hormone Replacement Therapy (HRT). Some doctors prescribe oestrogen (the main ingredient of HRT) or the contraceptive pill as treatment for osteoporosis in eating disorder sufferers as well. Others prescribe supplements of calcium or calcium + vitamin D to try to build up bone.
It is worth noting that, until controlled trials have been carried out, it is not clear which of these treatments are best for treating osteoporosis in people with EDs.
N.B. It is not a good idea to take any type of vitamin or mineral supplements without checking with your doctor first.

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Dhr. Bram Querido

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