Changes in trabecular bone score and bone density in female adolescents with anorexia nervosa: a longitudinal study

Dalit Modan-Moses, Ophir Megnazi, Liana Tripto-Shkolnik, Helit Talmor, Anat Toledano, Tal Shilton, Adi Enoch-Levy, Daniel Stein, Yael Levy-Shraga*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Impaired bone health is a common complication of anorexia nervosa (AN). We aimed to assess longitudinal changes in bone mineral density (BMD) and trabecular bone score (TBS), a measure of bone quality, in female adolescents with anorexia nervosa (AN). We conducted a retrospective longitudinal study of 41 female adolescents with AN who underwent two dual-energy X-ray absorptiometry (DXA) scans. Clinical data, including age, weight, height, body mass index (BMI), and DXA measurements were retrieved from the medical charts. Lumbar bone mineral apparent density (BMAD) was calculated to correct for size. Changes (Δ) in BMD, BMAD, and TBS were examined for correlations with clinical characteristics. Mean ages at the time of DXA scans were 14.8±1.9 and 16.8±2.0 years. There was a significant improvement in anthropometric parameters and DXA measurements at the second DXA scan. However, these values were still significantly lower than expected in the general population. The Δlumbar BMD Z-score was 0.3±0.7, the Δlumbar BMAD Z-score was 0.2±0.7 and the ΔTBS Z-score was 0.5±0.7. ΔTBS Z-score was positively correlated with Δheight Z-score, Δweight Z-score and ΔBMI Z-scores, and negatively correlated height Z-score, weight Z-score and TBS Z-scores at the first DXA scan (p<0.05). Δheight Z-score, ΔBMI Z-score and the progression from early to late puberty were identified as significant independent predictors of Δlumbar BMAD Z-score (p<0.05). During two years of treatment, both BMD and TBS increased significantly. Improvement in height and in weight status, and progression in puberty are predictors of improvement in BMD and TBS.

Original languageEnglish
Pages (from-to)416-423
Number of pages8
JournalJournal of Clinical Densitometry
Issue number3
StatePublished - 1 Jul 2022


  • Anorexia nervosa
  • bone mineral density
  • eating disorder
  • trabecular bone score


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