Medication for bone loss in female patients with anorexia nervosa: a systematic review and management algorithm

• Published in: Eating and weight disorders Vol. 30; no. 1; pp. 60 - 21
• Main Authors: Loisel, Alexandra, Li, Anne, Briot, Karine, Moro, Marie-Rose, Stheneur, Chantal, Blanchet, Corinne
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 04.08.2025; Springer Nature B.V; Springer
• Subjects: Algorithms; Anorexia; Anorexia nervosa; Anorexia Nervosa - complications; Anorexia Nervosa - drug therapy; Bisphosphonates; Bone density; Bone Density - drug effects; Bone Density Conservation Agents - therapeutic use; Bone Diseases, Metabolic - drug therapy; Bone Diseases, Metabolic - etiology; Bone loss; Bone mineral density; Clinical trials; Diphosphonates - therapeutic use; Estrogens; Female; Fractures; Humans; Medicine; Medicine & Public Health; Osteoporosis; Osteoporosis - drug therapy; Osteoporosis - etiology; Prevention; Psychiatry; Standard scores; Systematic review; Treatment; Osteoporosis; Systematic review; Bone mineral density; Treatment; Anorexia nervosa; Bone loss
• ISSN: 1590-1262; 1124-4909; 1590-1262
• DOI: 10.1007/s40519-025-01758-9

Purpose Anorexia Nervosa can have a major impact on bone health through low bone mass and bone loss. Considering the lack of consensual guidelines for the prevention and treatment of bone loss in this condition, a systematic review was performed to provide practical treatment guidance for clinicians. Methods We systematically searched Medline, Cochrane, Psychinfo, and the Web of Science for anorexia nervosa AND (osteopenia OR osteoporosis OR bone density OR bone loss) AND (prevention OR treatment OR medication OR therapeutic) in clinical studies from March 1st, 2017, to October 31st, 2024, and included the last systematic review on the subject. We excluded reviews, editorials, unfinished trials, expert opinions, book chapters, and case reports. This research followed the PRISMA guidelines. Results A total of 27 publications were included in this review. The main outcome measured was spinal bone mineral density (BMD). Among 1932 participants (all female), 1439 had AN and the remainder were healthy controls. Monotherapies mostly included various hormonal replacement therapies and bisphosphonates. Combination trials were performed on small numbers or with a modest time range or effect size. Results were statistically significant in 15 studies. Estrogen replacement therapy, bisphosphonates, teriparatide and denosumab showed the most significant effects. Conclusions These results and our clinical experience in the field allowed us to formulate a treatment algorithm for managing bone loss in patients with anorexia nervosa according to their BMD and pubertal status. Level of evidence Level I, systematic review