Anorexia and Bone Health
Current guidelines suggest that any woman with an
eating disorder who has not had her period in 6 months
receive a DEXA scan.
Physicians can use the graphic visual evidence provided
by the DEXA scan to educate the patient on the
severity of the disorder. It can be very helpful for a
patient to see that her bone density is equivalent to
that of an  80-year old woman.
Many of the physical ill effects of anorexia will subside
with weight restoration, but bone density does not.
Treatment is only successful at restoring 1--5 % .
Estrogen replacement therapy is the first line of
treatment to stabilize bone density in post-menopausal
women, but this has not proven as effective in anorexia
induced osteopenia and osteoporosis. Fred Hofeldt,
MD recommends repeating DEXA scans every 6- 12
months to "detect estrogen non-responders and initiate
additional therapeutic strategies".
Such additional strategies may include alendronate,
nasal calcitonin spray and raloxifene, sodium fluoride,
yet none of these strategies have any proven long term
data in anorexia nervosa.
When to prescribe an SSRI in BED and BN?
In Binge Eating
Disorder
normalization of
eating patterns
takes priority
over weight loss.
SSRI's are helpful in the treatment of both Bulimia
Nervosa and Binge Eating disorder. In bulimia, SSRI
treatment can often reduce binge purge symptoms by
50 %.
When does it make sense to prescribe an SSRI in the
case of Bulimia Nervosa? If the patient has not had
meaningful symptom reduction after 3 months of
psychotherapy according to Arnold Anderson, MD.  It
can also make sense to prescribe an SSRI if there has
always been an
underlying depression.
In the case of Binge Eating Disorder, Anderson
recommends beginning an SSRI at the onset of
treatment.  Use of an SSRI is not shown to assist in
weight reduction, instead, to reduce the frequency of
binge eating episodes.
Although most patients with binge eating disorder cite
weight loss at the top of their treatment goal,
normalization of eating patterns must take priority.
Book Review
If you are looking for a helpful guide to aid in
understanding and treating your patients with eating
disorders, Eating Disorders: A Guide to Medical Care
and Complications, edited by Philip Mehler and
Arnold Anderson (2000), may just fit the bill.
Mehler and Anderson are regular presenters at  
National Eating Disorder Association (NEDA)
and the International Association of Eating Disorder
Professionals (IADEP) conferences.
This book breaks down the impact of eating disorders
on each system of the body and takes into account
both the psychological and physiological implications
of these disorders.
The majority of citations in this newsletter have been
sourced from this text.