Osteoporosis Secondary to Anorexia Nervosa in Young Adult

Case at a Glance

A 24-year-old female with anorexia nervosa and secondary amenorrhea presents with bone density scan results revealing osteoporosis, particularly affecting the lumbar spine.

Patient's Story

The patient has a documented history of anorexia nervosa complicated by amenorrhea (cessation of menstrual periods). Due to concerns about bone health related to her eating disorder and hormonal changes, her healthcare provider ordered a bone density scan to assess for potential bone loss. The patient also has a history of tobacco use, which is an additional risk factor for bone density loss.

Initial Assessment

Given the patient's anorexia nervosa diagnosis with associated amenorrhea and tobacco use history, there was clinical suspicion for secondary osteoporosis. A dual-energy X-ray absorptiometry (DXA) scan was ordered to evaluate bone mineral density at key sites including the lumbar spine and bilateral hips.

The Diagnostic Journey

DXA bone densitometry was performed using a Lunar scanner, examining both hip and spine regions. The scan was technically adequate with no previous studies available for comparison. The examination revealed significant bone density loss, particularly in the lumbar spine region.

Final Diagnosis

Osteoporosis secondary to anorexia nervosa, confirmed by DXA scan results showing a lumbar spine T-score of -3.1, meeting WHO criteria for osteoporosis. Hip measurements showed osteopenia with T-scores ranging from -1.6 to -2.4.

Treatment Plan

Following National Osteoporosis Foundation recommendations: adequate calcium and vitamin D supplementation, regular weight-bearing and muscle-strengthening exercises, tobacco cessation counseling, and fall risk assessment and prevention strategies. Addressing the underlying anorexia nervosa and associated amenorrhea is crucial for bone health recovery.

Outcome and Follow-up

The patient was educated about her increased fracture risk, especially in the spine region. She demonstrated understanding of her condition and the importance of comprehensive treatment addressing both the eating disorder and bone health. Regular monitoring and follow-up DXA scans will be necessary to track bone density changes over time.