At some point in their life, most individuals assigned female at birth (AFAB) will end up talking about their bone health with a doctor. This is because later on in life, typically after menopause, many people AFAB experience a decline in bone health due to hormonal changes. However, for younger individuals bone health is rarely discussed, or is even a concern, when it should be. In this blog, we’ll explore the connection between eating disorders and bone health, as well as the lifelong complications that can occur.
Why is Bone Health So Important?
For many other individuals, bone health is not usually something that is ever discussed. Sure, maybe you saw the commercial about Ovaltine for strong bones in the early ’90s. Or heard about bones in the Got Milk? campaign of the 90s and 2000s. But bone health is not often acknowledged or discussed with young people, and it really should be.
It’s rather surprising actually, because only during adolescence does bone deposition happen faster than bone resorption. Essentially, adolescence is when the body’s bones are growing the most. Typically girls acquire up to 90% of peak bone mass by 18 years of age, and boys by age 20. Then, at age 20 the window closes for further deposition of bone density – meaning that the skeleton you have at 20 is the skeleton you have for the rest of your life.
How do Eating Disorders Affect Bone?
So how do eating disorders affect bone health? Well in order to fully answer this question, we first have to backtrack to how bones are formed.
The skeleton is actually considered one big organ that provides structure to the body. Our skeleton helps with mobility, support, protection, and stores essential minerals. The actual process of bone growth is fairly complicated, so for simplicity’s sake imagine that new bones are made from recycled old bones. Basically, your body uses existing bone to “supply” new bone growth. This process is happening constantly throughout your life and as a result, the body’s skeleton is replaced about every 10 years. However, it’s important to remember that most of the body’s bones are formed during adolescence. So if bone formation is stunted in adolescence, that means that the body will have a limited supply to use for bone growth in the future. This is where eating disorders can impair bone health.
When malnutrition, whether from an eating disorder or not, occurs the hypothalamus shuts down. The hypothalamus is an important part of the brain that controls hormone production, body temperature, hunger, heart rate, and mood. In order to conserve energy, the body shuts down any processes deemed “unnecessary,” like hormone production. This is why many women struggling with an eating disorder don’t get their periods.
This hormone shutdown, which can occur in both women and men, causes a decrease in estrogen, which then leads to a decrease in bone production and an increase in bone absorption. Therefore, the body isn’t producing enough new bone and is simultaneously absorbing too much bone, resulting in a deficit of bone density.
On top of that, the stress of an eating disorder can also exacerbate this deficiency. During an eating disorder, the brain will alert the body it’s in trouble through elevated levels of cortisol, the stress hormone. Cortisol also accelerates bone absorption, contributing to a loss of bone density. As you can probably guess, this type of deficit can impact the body in a variety of ways including…
- Bone collapse: bones can collapse and cause constant intense pain
- Injuries: a minor fall could result in a broken hip
- Height loss: If spinal columns have collapsed due to poor bone health individuals can notice they are inches shorter than they used to be.
How Do You Treat Eating Disorder-Induced Bone Loss?
So, what do you do if your child, or someone you know has an eating disorder and you are fearful for their bone health? Well, it is recommended to consult with a doctor who is eating disorder-aware as well as a therapist and dietitian. As HAES-aligned dietitians, we would also recommend finding providers who specialize in both eating disorders and HAES-aligned care to promote more successful recovery outcomes.
Some medical tests a doctor might order are serum estradiol, calcitonin, type 1 procollagen carboxy-terminal propeptide, vitamin D levels, and/or serum type 1 collagen carboxy-terminal telopeptide. The best diagnostic tool however for measuring bone density is the DEXA (dual-energy-ray absorptiometry) scan. When those AFAB lose their period a DEXA scan should be performed within a year. For those who do not lose their periods (or those AMAB) it is recommended to have a DEXA scan within a year of restrictive behaviors surrounding food to establish baseline bone health with continued monitoring.
Final Thoughts on Eating Disorders and Bone Health
Thank you for reading this resource on eating disorders and bone health. Although it is not spoken about often, bone health can impact so many aspects of life. When an adolescent is struggling with an eating disorder, the chronic effects on bone health are a major factor in why quick intervention is necessary and recommended. Prolonging recovery or taking it slow can have a major impact on an adolescent’s future especially surrounding bone health.
Sources: Gaudiani, J. L. (2018). Sick enough: A guide to the medical complications of eating disorders. Routledge.
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Courage to Nourish is a group of eating disorder specialized dietitians. We have in person locations in Alexandria, Virginia, Columbia, Maryland. and College Park, Maryland. We offer virtual services across the state of Virginia, Washington DC, Pennsylvania, and Colorado. We offer individual nutrition therapy. As well as support groups. We would love to guide you in building a better relationship with food.
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