Bone Fracture History in Women With First Episode or With Persistent Anorexia Nervosa.

Objective: To investigate fractures history in women with first episode anorexia nervosa (AN) (FE-AN: ≤ 3 years duration) and those with persistent AN (P-AN: ≥ 7 years), compared to healthy controls (HC).

Method: One hundred nineteen women (FE-AN = 49, P-AN = 46 and HC = 24) completed online questionnaires on eating disorders symptoms, their menstrual and their fracture history.

Results: Average illness duration was 1.9 years (SD = 0.8) in FE-AN and 15.3 years (SD = 8.5) in P-AN. Lifetime history of all fractures, including stress fractures, was higher in AN groups (FE-AN = 33.3%; P-AN = 37.8%) than in HC (4.2%, p < 0.001). P-AN participants were 13.4 times more likely to report a fracture compared to HC, irrespective of age, whereas F-AN participants were 10.3 times more likely. In P-AN, higher BMI, shorter duration of amenorrhoea and history of pregnancy were inversely associated with fracture number.

Conclusions: There is an increased risk of bone fracture even in the early stages of AN. This could be related to a time lapse between the initial symptoms of AN and formal diagnosis. This suggests guidelines recommending bone screening after 2-years of persistent low weight for adults should be revisited, and the risk of bone problems should be part of the dialogue between clinicians, patients and carers at the earliest opportunity.