Associations between bone mineral density, body composition and amenorrhoea in females with eating disorders: a systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational comparative studies
PubMed 36401318 · doi:10.1186/s40337-022-00694-8
What was done
PRISMA-guided systematic review and meta-analysis of studies published up to February 2022 evaluating bone mineral density (BMD, measured by dual-energy X-ray absorptiometry or dual photon absorptiometry) in females with eating disorders (anorexia nervosa [AN], bulimia nervosa [BN], binge-eating disorder [BED], or other specified feeding or eating disorders [OSFED]) compared to healthy controls. Primary outcomes were spine, hip, femur, and total body BMD. Meta-regressions evaluated the effects of fat mass, lean mass, body mass index (BMI), age, illness duration, oral contraceptive use, and amenorrhoea.
What was found
Across 43 included studies (N = 4,163 women, mean age 23.4 years, range 14.0–37.4), no studies on BED met inclusion criteria. BMD was lower than in healthy controls across total body, spine, hip, and femur for AN; across total body and spine for BN; and at the spine for OSFED. In meta-regression of women with any eating disorder (N = 2,058), low BMI, low fat mass, low lean mass, and amenorrhoea significantly predicted lower total body and spine BMD, while age and illness duration did not. In AN specifically, only low fat mass significantly predicted low total body BMD. Specific numerical effect sizes and confidence intervals were not reported in the abstract.
Why it matters
This review establishes that bone density loss is not confined to anorexia nervosa but also affects females with bulimia nervosa and OSFED. It highlights that monitoring body composition (fat and lean mass) and menstrual status provides valuable diagnostic information beyond BMI alone for bone health assessment.
Limits
No studies examining binge-eating disorder met inclusion criteria, preventing conclusions for that population. The underlying primary literature is observational, and the abstract does not report point estimates, confidence intervals, or between-study heterogeneity metrics.