Bone density is one of the biggest health concerns that I have for my clients with eating disorders. It's not uncommon for the anorexic client to tell me that she has been told by her doctor that she has the bone density of a 70 year-old woman. Huh? What does this mean?
It means that the client who is often quite young, like in her teens or in her 20s has very brittle bones. I will often show clients pictures of osteoporotic bones verses healthy bones taken with an electron microscope. The bones with osteoporosis are quite porous. As bones become less dense they become more susceptible to breaking.
When bone density begins to decrease, the diagnosis will be osteopenia. As this condition progresses it becomes osteoporosis. Both of these conditions are common in the anorexic population. I will frequently order a DEXA scan which is an x-ray that will reveal one's bone density.
It's unfortunate that bone density declines very rapidly in people with eating disorders. If an anorexic woman has stopped getting her period for greater than 6 months, she needs to have a DEXA to assess bone density. For a boy or man, a DEXA would be indicated if a low weight is maintained for 6 month or more. It has been so striking to me how many young people have brittle bones. This should be a time for healthy strong bone formation.
It's often hard to convey the importance of maintaining good bone health. Most of the time, these folks haven't had any symptoms like broken bones. Teens aren't usually concerned with long term consequences and especially with those that are invisible. Often I will try to explain that a slip and fall or a sports injury can result in months of rehabilitation of broken bones.
It's important to know that maintaining adequate weight is critical to prevent further bone density loss. I will test vitamin D levels and ensure this is supplemented, if needed. Calcium in food and supplements is supportive. So frequently, the restricted diet is void of calcium containing foods. I ensure that all our clients get some instruction on weight training with the reminder that this is for life.
Ultimately, a DEXA is good information for clients to have. I encourage them to use this information as motivation for recovery and for proof that their eating disorders really are unhealthy.