Question

1. Briefly describe anorexia nervosa and how a diet lacking in nutrients may contribute to an increased risk of bone fracture .

2. Due to anorexia nervosa Emily is experiencing amenorrhea, or the absence of her menstrual cycle. How might this symptom be related Emily’s fracture ?

Answer 1

The only reason for bone fractures is decreased serum calcium levels because of decreased intake of food and nutrients.

Please read the text below to understand the condition.

Anorexia nervosa

Epidemiology
Sex: ♀ > ♂ (10:1)
Peak age: 10–25 years of Aetiologylogy
Psychiatric factors: associated with OCD, anxiety disorders, and mood disorders
Psychosocial factors
Poor ability to handle/resolve conflicts
Difficulty establishing autonomy and gaining control
High-pressure careers and sports
Unrealistic standards of beauty
Features
Significant deliberate reduction in body mass (as measured by BMI) using strategies that include restrictive eating, purging, and excessive exercise.
Fear of weight gain
Body image disturbance
Excessive concern about weight and body shape, despite being considerably underweight
Lack of awareness of the seriousness of low body weight
Subtypes
Restricting type
No binge eating or purging over a 3-month period
Suggests weight loss is achieved by excessive dieting, exercise, or fasting
Binge-eating/purging type
Presence of binge eating or purging over a 3-month period
weight loss is achieved by vomiting, diuretic and laxative abuse, or enemas
Severity based on BMI
Patients ≤ 20 years of age: BMI below the 10th percentile for sex and age is considered the threshold for being underweight.
Patients > 20 years of age
Mild: BMI 17–18.4 kg/m2
Moderate: BMI 16–16.99 kg/m2
Severe: BMI 15–15.99 kg/m2
Extreme: BMI < 15 kg/m2
Other clinical features
CNS
Hypothermia
Seizures
Endocrine disorders
Stress hormones: ↑ cortisol, ↑ adrenaline
Thyroid: euthyroid sick syndrome
Secondary amenorrhea (severe weight loss suppresses the hypothalamic-pituitary-gonadal axis → hypogonadotropic hypogonadism)
Electrolyte abnormalities (e.g., hypokalemia
Heart: bradycardia, hypotension, cardiac arrhythmia
Bones: secondary osteoporosis and stress fractures
Skin and hair: dry skin, wound healing disorders, hair loss, lanugo body hair, Russell sign
Salivary glands: sialadenosis with dystrophy
Dental status: caries and perimolysis due to frequent vomiting
Blood: pancytopenia
Diagnostics
Physical exam: BMI < 18.5
Laboratory studies
Electrolyte imbalances: ↓ potassium, ↓ sodium, ↓ chloride, ↓ phosphate, ↓ magnesium, ↑ bicarbonate (metabolic alkalosis)
↑ Serum α-amylase
hypoproteinemia, hypoalbuminemia
Blood count: pancytopenia
Laboratory findings normalize following adequate treatment and weight gain!

Treatment
Psychotherapy (first-cognitive behavioural oral therapy
Psychodynamic psychotherapy
Nutritional support
nutritional support
Indications for hospitalization:
< 70% ideal body weight or BMI < 15 kg/m2
Unstable vital signs
Hypothermia
Bradycardia
Hypotension or symptoms of lightheadedness
Acute medical complications (e.g., syncope, seizures, pancreatitis, liver failure)
Arrhythmia
Hypoglycemia
Electrolyte disturbances
Complication: refeeding syndrome
Pathophysiology: very rapid increase in daily food intake can cause massive insulin release → increased displacement of magnesium, potassium, and phosphate (shift from extracellular to intracellular) → ↓ phosphate, ↓ potassium, ↓ magnesium
Clinical featuroedemadema, tachycardia (torsades de pointes), epileptic seizures, ataxia, rhabdomyolysis
Prophylaxis: limit initial dietary intake to 1000–1500 kcal/day
Prognosis
Chronic, relapsing disease
Mortality
Most commonly due to severe cachexia/starvation, cardiac failure, or suicide
Increased risk of comorbidities
Mood disorders (e.g., depression, bipolar disorder)
Obsessive-compulsive disorder
Individuals with eating disorders may switch from one disorder to another or show merging of symptoms, especially following treatment of one disorder!

Anorexia nervosa is associated with a high mortality rate because of associated medical complications (e.g., arrhythmia, bradycardia) and the high rate of suicide among individuals with the disease

I hope you were able to understand the condition.

Please rate if helps us motivate and answer your ques