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Eating disorders and bone health

Without intervention, the damage to bones caused by eating disorders can lead to lifelong complications, underscoring the importance of early treatment and comprehensive care.
3D rendering of bone structure in osteoporosis

Eating disorders are serious mental health conditions that can profoundly impact physical health. Among many health consequences, compromised bone health stands out as a concern due to its potential for long-term skeletal complications.

Eating disorders are serious mental health conditions that can profoundly impact physical health. Among many health consequences, compromised bone health stands out as a concern due to its potential for long-term skeletal complications.

How eating disorders affect bone health

Nutritional deficiencies: maintaining healthy bones relies on nutrients such as calcium, vitamin D, magnesium and protein. Eating disorders often involve restrictive diets, purging, or excessive exercise, which can lead to deficiencies in these key nutrients.

Hormonal imbalances: in individuals with eating disorders that cause excessive weight loss, low body weight and fat percentage disrupt hormone production, including oestrogen and testosterone. These hormones play essential roles in bone density maintenance1.

Loss of menstrual cycles (amenorrhea) due to low oestrogen levels exacerbates bone loss; similar to what occurs during menopause but at a much younger age.

Impact of low body weight: reduced body mass places less mechanical stress on bones, leading to lower bone formation and weaker skeletal structure2.

Increased cortisol levels: chronic stress associated with eating disorders raises cortisol levels3, which can negatively affect bone remodelling and increase bone loss4. 

graphic showing the impact of eating disorders on bone health

How eating disorders affect bone health

Nutritional deficiencies: maintaining healthy bones relies on nutrients such as calcium, vitamin D, magnesium and protein. Eating disorders often involve restrictive diets, purging, or excessive exercise, which can lead to deficiencies in these key nutrients.

Hormonal imbalances: in individuals with eating disorders that cause excessive weight loss, low body weight and fat percentage disrupt hormone production, including oestrogen and testosterone. These hormones play essential roles in bone density maintenance1.

Loss of menstrual cycles (amenorrhea) due to low oestrogen levels exacerbates bone loss; similar to what occurs during menopause but at a much younger age.

Impact of low body weight: reduced body mass places less mechanical stress on bones, leading to lower bone formation and weaker skeletal structure2.

Increased cortisol levels: chronic stress associated with eating disorders raises cortisol levels3, which can negatively affect bone remodelling and increase bone loss4. 

graphic showing the impact of eating disorders on bone health
doctor using pen to point at X-ray of legs

Long-term skeletal complications

If untreated, the bone damage caused by eating disorders can lead to:

Osteopenia and osteoporosis: reduced bone mineral density increases the risk of fractures, even from minor injuries.

Delayed peak bone mass development: adolescents and young adults may fail to achieve peak bone density during critical growth years5. Peak bone mass is a key major determinant of bone mass and fragility fractures later in life6. 

Chronic pain and impaired mobility: fragile bones can lead to frequent fractures, spinal deformities, and reduced quality of life7.

doctor using pen to point at X-ray of legs

Long-term skeletal complications

If untreated, the bone damage caused by eating disorders can lead to:

Osteopenia and osteoporosis: reduced bone mineral density increases the risk of fractures, even from minor injuries.

Delayed peak bone mass development: adolescents and young adults may fail to achieve peak bone density during critical growth years5. Peak bone mass is a key major determinant of bone mass and fragility fractures later in life6. 

Chronic pain and impaired mobility: fragile bones can lead to frequent fractures, spinal deformities, and reduced quality of life7.

The importance of early intervention

The primary and most crucial intervention is addressing the eating disorder itself. While this process is often long and complicated, it serves as the foundation for achieving long-term physical health and psychological well-being. 

By prioritising early intervention, individuals can reduce the risk of severe complications, including those affecting bone health. 

Medical and nutritional monitoring: early diagnosis allows healthcare professionals to address malnutrition and deficiencies before significant bone loss occurs.

Multidisciplinary approach: effective intervention involves collaboration between doctors, dietitians, and mental health professionals to ensure comprehensive care.

Nutritional rehabilitation: restoring a healthy and balanced diet is vital for replenishing nutrient stores essential for bone growth and repair.

Education and awareness: raising awareness about the link between eating disorders and bone health is key to encouraging individuals to seek help sooner.

The importance of early intervention

The primary and most crucial intervention is addressing the eating disorder itself. While this process is often long and complicated, it serves as the foundation for achieving long-term physical health and psychological well-being. 

By prioritising early intervention, individuals can reduce the risk of severe complications, including those affecting bone health. 

Medical and nutritional monitoring: early diagnosis allows healthcare professionals to address malnutrition and deficiencies before significant bone loss occurs.

Multidisciplinary approach: effective intervention involves collaboration between doctors, dietitians, and mental health professionals to ensure comprehensive care.

Nutritional rehabilitation: restoring a healthy and balanced diet is vital for replenishing nutrient stores essential for bone growth and repair.

Education and awareness: raising awareness about the link between eating disorders and bone health is key to encouraging individuals to seek help sooner.

woman stood on marodyne liv device on low pile carpet floor

The role of LiV therapy in bone density restoration

LiV (Low-intensity Vibration) therapy with the Marodyne LiV has shown to improve, and in some cases reverse, bone loss in adolescents and adults with anorexia. 

While deficits in bone density may be improved by weight-bearing exercise, physical activity in those with low body weight can slow the process of weight restoration – the cornerstone of long term medical and psychological well-being. 

LiV therapy offers a safe, natural alternative that can be used throughout recovery and beyond to protect bone health. It can be employed in care plans as an intervention that does not impede weight restoration nor contribute to potential psychological risk associated with physical activity in people at any stage of their recovery journey. 

A 2009 study found that 12 months of LiV therapy increased bone and muscle mass in young women and adolescents aged 15-20 who had already sustained a fracture8. Another study, published in 2024, found a positive increase in bone turnover and bone quality from LiV therapy in just six months9. An earlier study from 2017 found that LiV therapy prevents bone quality decline in individuals who are hospitalised for anorexia, even over short time periods10. 

Discover more about Low-intensity Vibration therapy by clicking the button below.

woman stood on marodyne liv device on low pile carpet floor

The role of LiV therapy in bone density restoration

LiV (Low-intensity Vibration) therapy with the Marodyne LiV has shown to improve, and in some cases reverse, bone loss in adolescents and adults with anorexia. 

While deficits in bone density may be improved by weight-bearing exercise, physical activity in those with low body weight can slow the process of weight restoration – the cornerstone of long term medical and psychological well-being. 

LiV therapy offers a safe, natural alternative that can be used throughout recovery and beyond to protect bone health. It can be employed in care plans as an intervention that does not impede weight restoration nor contribute to potential psychological risk associated with physical activity in people at any stage of their recovery journey. 

A 2009 study found that 12 months of LiV therapy increased bone and muscle mass in young women and adolescents aged 15-20 who had already sustained a fracture8. Another study, published in 2024, found a positive increase in bone turnover and bone quality from LiV therapy in just six months9. An earlier study from 2017 found that LiV therapy prevents bone quality decline in individuals who are hospitalised for anorexia, even over short time periods10. 

Discover more about Low-intensity Vibration therapy by clicking the button below.

If you or anyone you know is struggling with an eating disorder, help is available. 

If you or anyone you know is struggling with an eating disorder, help is available. 

References

  1. Karsenty G (2012). The mutual dependence between bone and gonads, Journal of Endocrinology. 213(2): 107-114.
  2. Hunter G, Plaisance P & Fisher G (2014). Weight Loss and Bone Mineral Density, Curr Opin Endocrinol Diabetes Obes. 21(5): 358–362.
  3. Da Luz Neto, et al,. (2019). Differences in cortisol concentrations in adolescents with eating disorders: a systematic review, J Pediatr (Rio J). 95(1):18-26. 
  4. Weaver C (2022). Cortisol and Bone Loss, The Arthritis Connection. [Online] Available at: www.thearthritisconnection.com/rheumatoid-arthritis/cortisol-and-bone-loss 
  5. Rozenberg S, et al. (2020). How to manage osteoporosis before the age of 50, Maturitas. 138:14-25.
  6. Chevalley T & Rizzoli R (2022). Acquisition of peak bone mass, Best Practice & Research Clinical Endocrinology & Metabolism. 36(2):101616.
  7. British Nutrition Foundation (2023) Osteoporosis and Nutrition. [Online] Available at: www.nutrition.org.uk/health-conditions/osteoporosis-and-nutrition/ 
  8. Gilsanz V, et al. (2009). Low-Level, High-Frequency Mechanical Signals Enhance Musculoskeletal Development of Young Women With Low BMD, JBMR. 21(9): 1464-1474. 
  9. DiVasta A, et al. (2024). Low-Magnitude Mechanical Signals to Preserve Skeletal Health in Female Adolescents With Anorexia Nervosa: A Randomized Clinical Trial, JAMA Netw Open. 7(10):e2441779.
  10. DiVasta A, et al. (2017). The Ability of Low Magnitude Mechanical Signals to Normalize Bone Turnover in Adolescents Hospitalized for Anorexia Nervosa, Osteoporosis Int. 28(4):1255–1263. 

References

  1. Karsenty G (2012). The mutual dependence between bone and gonads, Journal of Endocrinology. 213(2): 107-114.
  2. Hunter G, Plaisance P & Fisher G (2014). Weight Loss and Bone Mineral Density, Curr Opin Endocrinol Diabetes Obes. 21(5): 358–362.
  3. Da Luz Neto, et al,. (2019). Differences in cortisol concentrations in adolescents with eating disorders: a systematic review, J Pediatr (Rio J). 95(1):18-26. 
  4. Weaver C (2022). Cortisol and Bone Loss, The Arthritis Connection. [Online] Available at: www.thearthritisconnection.com/rheumatoid-arthritis/cortisol-and-bone-loss 
  5. Rozenberg S, et al. (2020). How to manage osteoporosis before the age of 50, Maturitas. 138:14-25.
  6. Chevalley T & Rizzoli R (2022). Acquisition of peak bone mass, Best Practice & Research Clinical Endocrinology & Metabolism. 36(2):101616.
  7. British Nutrition Foundation (2023) Osteoporosis and Nutrition. [Online] Available at: www.nutrition.org.uk/health-conditions/osteoporosis-and-nutrition/ 
  8. Gilsanz V, et al. (2009). Low-Level, High-Frequency Mechanical Signals Enhance Musculoskeletal Development of Young Women With Low BMD, JBMR. 21(9): 1464-1474. 
  9. DiVasta A, et al. (2024). Low-Magnitude Mechanical Signals to Preserve Skeletal Health in Female Adolescents With Anorexia Nervosa: A Randomized Clinical Trial, JAMA Netw Open. 7(10):e2441779.
  10. DiVasta A, et al. (2017). The Ability of Low Magnitude Mechanical Signals to Normalize Bone Turnover in Adolescents Hospitalized for Anorexia Nervosa, Osteoporosis Int. 28(4):1255–1263. 
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