Increased Bone Marrow Fat in Anorexia Nervosa

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Abstract

Context:

Although women with anorexia nervosa (AN) have severe depletion of body fat, a paradoxical increase in bone marrow fat has been described. Recent data suggest that marrow fat measured by 1H-magnetic resonance spectroscopy (MRS) in combination with bone mineral density (BMD) may be more valuable than either parameter alone in detecting bone weakness.

Objective:

The objective of the study was to investigate the effect of AN on accumulation of marrow fat in spine and femur using 1H-MRS and the relationship between marrow fat, BMD, and body composition in subjects with AN and normal-weight controls.

Design:

This was a cross-sectional study.

Setting:

The study was conducted at a referral center.

Patients:

Patients included 10 women with AN (29.8 ± 7.6 yr) and 10 normal-weight age-matched women (29.2 ± 5.2 yr).

Interventions:

There were no interventions.

Main Outcomes Measure:

Marrow fat content of the fourth lumbar vertebra and femur measured by 1H-MRS. BMD of spine and hip measured by dual-energy x-ray absorptiometry.

Results:

Subjects with AN had higher marrow fat at the fourth lumbar vertebra and femur compared with controls (P = 0.004-0.01). There was an inverse correlation between marrow fat of L4 and femur and BMD of the spine and hip (r = −0.56 to −0.71, P = 0.01-0.0002) and body mass index and sc adipose tissue of the thigh (r = −0.49 to −0.71, P = 0.03-0.0007). There was an inverse correlation between femur marrow fat and sc and total abdominal adipose tissue (r = −0.53 to −0.67, P = 0.003-0.03).

Conclusion:

Women with AN have greater lumbar and femoral marrow fat than controls, and marrow fat correlates inversely with BMD. This paradoxical increase in marrow fat at a time when sc and visceral fat are markedly reduced raises important questions about functional consequences of this process.

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