Anorexia nervosa (AN) is an increasingly common disorder in adolescent girls, with a prevalence of 0.2 to 1.0% in Western societies. Adolescence is a critical time for bone mineral accretion as more than 90% of peak bone mass is established during this time, and peak bone mass is a major determinant of osteoporosis and fracture risk throughout life. Factors critical to the marked increase in bone mass through puberty include rising levels of estrogen, and estrogen induced increases in growth hormone and insulin like growth factor-1 (IGF-1). Low bone density is a frequent complication of adolescents with AN, and is concerning for increased fracture risk. Mechanisms underlying the low bone density characteristic of AN include profound estrogen deficiency and very low levels of IGF-1. Thus far, there are no established therapies to maximize bone mass accrual and peak bone mass in teenagers with AN, and prevent fractures. Although AN is associated with profound IGF-1 and estrogen deficiency, both of which are critical to bone development, effects of administration of recombinant human rhIGF-1 with estrogen versus estrogen alone has not been investigated in adolescents with this disorder. In addition, the effect of AN on bone microarchitecture, a better indicator of fracture risk than bone density or bone strength, has not been prospectively examined. In the current proposal, effects of administration of rhIGF-1 and estrogen versus estrogen alone will be studied. In the first specific aim we will prospectively investigate the effect of rhIGF-1 and estrogen vs. estrogen alone on bone density and bone turnover in adolescent girls with AN and compare bone accrual to normal adolescents. In the second aim, we will investigate the effects of rhIGF-1 and estrogen on bone microarchitecture and bone strength in adolescents with AN. These studies will be essential in developing strategies to address the profound loss of bone accrual seen in this large population of adolescent girls at high fracture risk.

Public Health Relevance

Low bone density is characteristic of anorexia nervosa, a condition that is very prevalent in Adolescence. Because these years are critical to attainment of peak bone mass, an important determinant of bone health and fracture risk in later life, the onset of anorexia nervosa in the adolescent years is particularly worrisome. This proposal will examine possible therapeutic strategies to increase bone density and optimize peak bone mass in adolescents with anorexia nervosa.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project (R01)
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Special Emphasis Panel (ZRG1-MOSS-C (04))
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Malozowski, Saul N
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Massachusetts General Hospital
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Fazeli, Pouneh K; Klibanski, Anne (2018) Effects of Anorexia Nervosa on Bone Metabolism. Endocr Rev 39:895-910
Singhal, Vibha; Tulsiani, Shreya; Campoverde, Karen Joanie et al. (2018) Impaired bone strength estimates at the distal tibia and its determinants in adolescents with anorexia nervosa. Bone 106:61-68
Kandemir, Nurgun; Becker, Kendra; Slattery, Meghan et al. (2017) Impact of low-weight severity and menstrual status on bone in adolescent girls with anorexia nervosa. Int J Eat Disord 50:359-369
Baskaran, Charumathi; Carson, Traci L; Campoverde Reyes, Karen J et al. (2017) Macronutrient intake associated with weight gain in adolescent girls with anorexia nervosa. Int J Eat Disord 50:1050-1057
Misra, Madhusmita; Ackerman, Kathryn E; Bredella, Miriam A et al. (2017) Racial Differences in Bone Microarchitecture and Estimated Strength at the Distal Radius and Distal Tibia in Older Adolescent Girls: a Cross-Sectional Study. J Racial Ethn Health Disparities 4:587-598
Misra, Madhusmita; Golden, Neville H; Katzman, Debra K (2016) State of the art systematic review of bone disease in anorexia nervosa. Int J Eat Disord 49:276-92
Misra, Madhusmita; Klibanski, Anne (2016) Anorexia Nervosa and Its Associated Endocrinopathy in Young People. Horm Res Paediatr 85:147-57
Misra, Madhusmita; Klibanski, Anne (2014) Anorexia nervosa and bone. J Endocrinol 221:R163-76
Faje, Alexander T; Fazeli, Pouneh K; Miller, Karen K et al. (2014) Fracture risk and areal bone mineral density in adolescent females with anorexia nervosa. Int J Eat Disord 47:458-66
Singhal, Vibha; Misra, Madhusmita; Klibanski, Anne (2014) Endocrinology of anorexia nervosa in young people: recent insights. Curr Opin Endocrinol Diabetes Obes 21:64-70

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