Osteoporosis is a recognised complication of anorexia nervosa, in part because of oestrogen deficiency.1 Data on the effect of oestrogen supplementation in osteoporotic patients with anorexia nervosa are limited. The effect of oestrogen supplementation on bone density in a patient with severe osteoporosis because of anorexia nervosa is reported.

The patient presented at the age of 26 years with a history of intermittent back pain and kyphosis. Her menarche was at the age of 13 years when she weighed 53 kg. At that time she developed a restrictive eating habit but continued to menstruate until the age of 19 years when she became amenorrhoeic and weighed 32 kg. Although she received psychological support her weight only improved temporarily. She remained underweight at 41 kg for the two years preceding presentation. The patient admitted to drinking minimal amounts of milk, although did have yoghurts regularly. The only exercise she did was walking as part of daily activities. There was no history of binge eating or vomiting and she denied laxative, diuretic, alcohol or drug abuse.

On examination her height was 1.57 m, weight 41 kg …