Up to one-third of peak bone density is achieved during puberty. Anorexia is typically identified during mid to late adolescence, a critical period for bone development. The longer the duration of the disorder, the greater the bone loss and the less likely it is that bone mineral density will ever return to normal.
The primary goal of medical therapy for individuals with anorexia is weight gain and, in females, the return of normal menstrual periods. However, attention to other aspects of bone health is also important.
Nutrition: A well-balanced diet rich in calcium and vitamin D is important for healthy bones. Good sources of calcium include low-fat dairy products; dark green, leafy vegetables; and calcium-fortified foods and beverages. Supplements can help ensure that people get adequate amounts of calcium each day, especially in people with a proven milk allergy. The Institute of Medicine recommends a daily calcium intake of 1,000 mg (milligrams) for men and women, increasing to 1,200 mg for those age 50 and older.
Vitamin D plays an important role in calcium absorption and bone health. It is synthesized in the skin through exposure to sunlight. Food sources of vitamin D include egg yolks, saltwater fish, and liver. Many people obtain enough vitamin D by getting about 15 minutes of sunlight each day; others may need vitamin D supplements to achieve the recommended intake of 400 to 600 International Units (IU) each day.
Exercise: Like muscle, bone is living tissue that responds to exercise by becoming stronger. The best activity for your bones is weight-bearing exercise that forces you to work against gravity. Some examples include walking, climbing stairs, lifting weights, and dancing.
Although walking and other types of regular exercise can help prevent bone loss and provide many other health benefits, these potential benefits need to be weighed against the risk of fractures, delayed weight gain, and exercise-induced amenorrhea in people with anorexia and those recovering from the disorder.
Healthy lifestyle: Smoking is bad for bones as well as the heart and lungs. In addition, smokers may absorb less calcium from their diets. Alcohol also can have a negative effect on bone health. Those who drink heavily are more prone to bone loss and fracture, because of both poor nutrition and increased risk of falling.
Bone density test: A bone mineral density (BMD) test measures bone density in various parts of the body. This safe and painless test can detect osteoporosis before a fracture occurs and can predict one’s chances of fracturing in the future. The BMD test can help determine whether medication should be considered.
Medication: There is no cure for osteoporosis. However, medications are available to prevent and treat the disease in postmenopausal women, men, and both women and men taking glucocorticoid medication. Some studies suggest that there may be a role for estrogen preparations among girls and young women with anorexia. However, experts agree that estrogen should not be a substitute for nutritional support.