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FRI0535 Strong influence of vitamin d status on bone mineral density and bone turnover markers during weight restoration in patients with anorexia nervosa
  1. A Giollo1,
  2. L Idolazzi1,
  3. C Caimmi1,
  4. A Fassio1,
  5. F Bertoldo2,
  6. R Dalle Grave3,
  7. S Calugi3,
  8. PV Bazzani3,
  9. O Viapiana1,
  10. M Rossini1,
  11. D Gatti1
  1. 1Rheumatology Unit, Department of Medicine
  2. 2Internal Medicine Unit, Department of Medicine, University of Verona, Verona
  3. 3Department of Eating and Weight Disorder, Villa Garda Hospital, Garda, Italy

Abstract

Background Anoressia nervosa (AN) is associated with an increased risk of low bone mineral density (BMD) and fractures as a consequence of an inadequate bone mass peak in adolescence and bone loss in young adulthood. Moreover, recently we have showed that vitamin D (25-OH-D) deficiency is widespread in untreated patients with AN, and there is a strong positive relationship between vitamin D status and BMD in AN. However, if vitamin D status could affect the efficacy of weight restoration in improving bone health in patients with AN is currently unknown.

Objectives Our aim was to investigate the potential role of vitamin D status in determining the efficacy on bone mineral density (BMD) of weight restoration in AN.

Methods Bone mineral density assessed by dual-energy x-ray absorptiometry (DXA), vitamin D, N-propeptide of type I collagen (P1NP), C-terminal telopeptide of type I collagen (CTX), intact parathyroid hormone (PTH) were evaluated before and after a 20-weeks intensive weight restoration therapy in patients with anorexia nervosa and secondary amenorrhoea for at least 6-months. The subjects were not receiving medications known to affect bone metabolism.

Results Ninety-one female patients aged 13–45 years old were evaluated, baseline weight 39.4±5.6 kg and BMI 15.1±1.6 kg/m2. Weight and BMI were significantly increased in all patients after treatment. The mean BMD values were significantly increased only at the spine (1.0±3.6%, p=0.009). A positive trend was demonstrated between post-treatment 25-OH-D and BMD changes at the spine (p=0.032). However, only the patients with post-treatment 25-OH-D ≥30 ng/ml showed significantly higher increases in BMD at the spine (2.5% vs 0.5% respectively for 25-OH-D ≥30 ng/ml and 25-OH-D <30 ng/ml, p<0.03; Figure 1). Both P1NP and PTH increased, whereas a significant decrease was found in 25-OH-D and CTX (p<0.05). Post-treatment CTX levels were inversely correlated with spine BMD. A positive relationship was found between changes in weight and P1NP (R2 =0.27).

Conclusions In anorexia nervosa, a hypovitaminosis D status counteracts the efficacy of the weight restoration treatment because of an increase in bone resorption mediated by a secondary hyperparathyroidism. Our study strongly support the use of vitamin D supplements for bone health in anorexia nervosa.

Disclosure of Interest None declared

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