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Regional Osteoporosis in Anorexia Nervosa
- Steven Grinspoon, MD; and
- Anne Klibanski, MD
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IN RESPONSE:
We agree with Dr. Mehler's comments. We have previously shown that leptin levels are tightly regulated by adipose tissue in women with the restricting subtype of anorexia nervosa (1). Recently, Ducy and colleagues (2) demonstrated that leptin itself may inhibit bone formation through central mechanisms in leptin-deficient and wild-type mice. In women with anorexia nervosa, we have found that low leptin levels are associated with osteopenia and osteoporosis (1). Therefore, we believe that in this population, leptin is more likely to be a marker of fat loss and generalized undernutrition than a determinant of bone density. We agree with Dr. Mundy (3) and with Dr. Mehler that bone loss in patients with anorexia nervosa is multifactorial and may be due to hormonal, nutritional, and other variables. Furthermore, we agree that our cross-sectional data and data from previous longitudinal studies (4) suggest that estrogen therapy is not sufficient to restore bone density in women with anorexia nervosa. The minimal effects of estrogen are probably related to the fact that bone loss in women with anorexia nervosa is the result not only of estrogen deficiency but of nutritional deficiencies, which may contribute independently to bone loss. We agree that although bisphosphonates have never been tested in patients with anorexia nervosa, further research is necessary to determine whether they may be effective in preventing bone loss.
Steven Grinspoon, MD
Anne Klibanski, MD
Harvard Medical School
Boston, MA 02114
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
