The link between anorexia and osteoporosis

Osteoporosis is rarely associated with young people but in the case of individuals living with or recovering from anorexia – a disease that affects a disproportionate number of teenagers and young adults – the risk of bone loss leading to osteopenia and osteoporosis is very real and very high.

It’s thought that up to 90% of people with anorexia have osteopenia – the bone thinning disease that, if left untreated, leads to osteoporosis. And around 1/3 of people with anorexia will have full-blown osteoporosis.

As with anyone who has osteopenia or osteoporosis, the risk of fractures is far higher. Sadly, even when (and if) healthier eating patterns and weight resume, the damage to the weakened bone can be hard to reverse.

How anorexia damages bones

Being invisible, low bone mineral density (BMD), osteopenia and osteoporosis are often overlooked in people with anorexia as the more obvious visible symptoms – such as changing physique, thinning hair and dry skin – take precedence.  But the threat to bones cannot be ignored.

Anorexia damages bones through a number of ways:

  • Low oestrogen – vital for bone formation, levels of this hormone drop in someone with anorexia with the first sign of this being stopping of monthly periods
  • High stress – the body’s natural response to starvation is production of cortisol – a steroid hormone that accelerates bone loss
  • Reducing/eliminating Vitamin D, calcium, magnesium and other nutrients vital for healthy bones as a result of a restricted diet

Why younger people are particularly at risk.

Anorexia can be a double-edged sword when it comes to bone health as it disproportionately affects more teenagers and young adults compared to older adults. It is during these teenage/formative years that bone mass formation should be at its peak before slowing down from the age 20. People who have anorexia in their teens and early 20s will halt this normal process of rapid bone formation that should see them safely into later life.

The earlier anorexia starts and the longer it affects an individual the worse it is for bones: in most cases, the damage will be irreversible.  Finally, studies show that young females with anorexia have lower bone density than older adults, even if they’ve had the illness for the same duration.

Boys and young men are affected, too

Anorexia and osteoporosis aren’t readily associated with men. However, they can – and are – affected. Furthermore, men with anorexia tend to over exercise to a far greater degree than women living with the disease which, in turn, reduces puts their weak bones under even more stress.  A dangerous combination of factors.

When exercise IS bad for you

Ordinarily, people are advised to take regular weight-bearing exercise to boost their bone health. Walking, running, lifting weights, dancing and gym work are all recommended to boost bone production – but only in people who are a healthy weight and have a balanced intake of bone-forming nutrients.

For people living with or recovering from anorexia, exercise is often not advised as it leads to further weight loss, compounding the impact of the disease.  Ironically, when restricting exercise to help recovery from anorexia, the bones are denied the physical stimulus they need to rebuild.

How best to tackle it

First and foremost, people with anorexia should treat their eating disorder. The disease doesn’t just affect bone density – major organs are at risk of damage and failure so restoring a healthy diet and lifestyle is of paramount importance.

As diet and lifestyle improve, hormone levels can stabilise while the better food intake will start to return nutrients to the bone.  Additional vitamin D and calcium supplements are likely to be added to ensure adequate levels to help new bone tissue form.

However, as with anyone who has osteoporosis or osteopenia, these nutrients will help but can’t, on their own, restore bone tissue. A key ingredient to help attract the right minerals into the bone matrix and hold them there is collagen optimised for bone tissue, such as bonebalance.

Can medication help?

Older people with osteoporosis are often given medication to help their bone density but this is rarely recommended for younger people – even those with anorexia – as it’s unsafe to continue use over a long period of time. Given that bone turnover will need to be boosted for the rest of their life, it’s simply not tenable to think drugs can help long term.

It is far better to look to restore bone health and bone density through nutrient dense foods. Again, bonebalance can help to fast track this replenishing of bone tissue.  A Food For Special Medical Purposes for low bone mineral density, osteopenia and osteoporosis, it’s ideal.

As a protein, bonebalance has calories – just 20 per 5g daily serving. While a small amount, this may cause concern to a recovering anorexic for whom every calorie counts. However, given the importance of restoring bone tissue, it must be hoped that people looking to recover their strength and safeguard their future health will prioritise these highly nutritious calories in their programme.

Where to find help

If you or somebody you know is affected by anorexia it is essential that you seek professional help and guidance. Although anorexia presents as a significant physical change, it is in fact a mental health illness and expertly trained counsellors and psychiatrists will be just as important to recovery as nutritionists and doctors.

Discreet, professional help can be found: