Bone Density Measurement in Anorexia Nervosa: A Missed Opportunity

Background/Objectives: Loss of bone mineral density is a common, serious, and often irreversible complication of anorexia nervosa (AN). However, it can be detected by a simple procedure termed dual-energy X-ray absorptiometry (DXA). Methods: We review adherence to guidelines, which discuss when this test should be obtained, via a retrospective review of 174 participants treated at a residential treatment center. Electronic health records were reviewed to determine the participants’ most recent DXA. Results: Seventy-six people (43.7%) had prior DXAs. Of these, 20 (26.3%) reported their DXAs demonstrated no bone disease. For patients with prior DXA, 48 (63.2%) reported awareness of bone disease, and having any bone disease was significantly more likely than having none (χ2 = 11.53, p < 0.001). Older patients were more likely to have a prior DXA (OR = 1.07, 95% CI [1.04, 1.10], p < 0.001). Ten (13.1%) people under age 25 had bone disease. People with a longer duration of illness were more likely to have a prior DXA (OR = 1.08, 95% CI [1.04, 1.12], p < 0.001). Conclusions: This study demonstrates poor adherence to obtaining DXA testing in AN. This is likely due to “clinical inertia” and lack of clear guidelines, and needs to be addressed to avert long-term adverse sequelae, especially because successful refeeding and weight restoration may not be sufficient to prevent ongoing loss of bone mineral density.