Bone marrow adipose tissue is associated with fracture history in anorexia nervosa

T Dang; A T Faje; E Meenaghan; M A Bredella; M L Bouxsein; A Klibanski; P K Fazeli

doi:10.1007/s00198-022-06527-3

Bone marrow adipose tissue is associated with fracture history in anorexia nervosa

Osteoporos Int. 2022 Dec;33(12):2619-2627. doi: 10.1007/s00198-022-06527-3. Epub 2022 Aug 23.

Authors

T Dang¹, A T Faje^{1

2}, E Meenaghan¹, M A Bredella^{2

3}, M L Bouxsein^{2

4

5}, A Klibanski^{1

2}, P K Fazeli^{6

7

8}

Affiliations

¹ Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA.
² Harvard Medical School, Boston, MA, USA.
³ Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
⁴ Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁵ Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA.
⁶ Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA. pkfazeli@pitt.edu.
⁷ Harvard Medical School, Boston, MA, USA. pkfazeli@pitt.edu.
⁸ Neuroendocrinology Unit, Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. pkfazeli@pitt.edu.

Abstract

Although bone mineral density (BMD) is decreased and fracture risk increased in anorexia nervosa, BMD does not predict fracture history in this disorder. We assessed BMD, bone microarchitecture, and bone marrow adipose tissue (BMAT) in women with anorexia nervosa and found that only BMAT was associated with fracture history.

Introduction: Anorexia nervosa (AN) is a psychiatric disorder characterized by low body weight, low BMD, and increased risk of fracture. Although BMD is reduced and fracture risk elevated, BMD as assessed by DXA does not distinguish between individuals with versus those without prior history of fracture in AN. Despite having decreased peripheral adipose tissue stores, individuals with AN have enhanced bone marrow adipose tissue (BMAT), which is inversely associated with BMD. Whether increased BMAT is associated with fracture in AN is not known.

Methods: We conducted a cross-sectional study in 62 premenopausal women, including 34 with AN and 28 normal-weight women of similar age. Fracture history was collected during patient interviews and BMD measured by DXA, BMAT by ¹H-MRS, and parameters of bone microarchitecture by HR-pQCT.

Results: Sixteen women (47.1%) with AN reported prior history of fracture compared to 11 normal-weight women (39.3%, p = 0.54). In the entire group and also the subset of women with AN, there were no significant differences in BMD or parameters of bone microarchitecture in women with prior fracture versus those without. In contrast, women with AN with prior fracture had greater BMAT at the spine and femur compared to those without (p = 0.01 for both).

Conclusion: In contrast to BMD and parameters of bone microarchitecture, BMAT is able to distinguish between women with AN with prior fracture compared to those without. Prospective studies will be necessary to understand BMAT's potential pathophysiologic role in the increased fracture risk in AN.

Keywords: Anorexia nervosa; Bone marrow adipose tissue; Fracture.

MeSH terms

Absorptiometry, Photon
Adipose Tissue / diagnostic imaging
Anorexia Nervosa* / complications
Bone Density / physiology
Bone Marrow
Cross-Sectional Studies
Female
Fractures, Bone*
Humans
Prospective Studies

Abstract

MeSH terms

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