Eating Disorders and Musculoskeletal Health
Anorexia and bulimia can cause early bone loss, fractures, and muscle wasting. What every young person, parent, and physician should know.
I remember watching Good Morning America a few years ago when the beloved meteorologist Ginger Zee spoke publicly about eating disorders, and last year I read Kerry Washington's memoir, 'Thicker Than Water,' where she revealed her struggle with an eating disorder during college. Numerous celebrities have spoken up about their struggles. In college, I witnessed many women struggle with body image and the need to have an 'ideal' body type. Although I grew up immersed in the dance and figure skating world, where body type, weight, and self-image are discussed often, I didn't see this struggle up close until college, especially during my sophomore year, after many of us gained the 'freshman 15' (or, in my case, the freshman 30). It is so wonderful that so many women and men have been vulnerable and shared their stories.
Being aware. As a rheumatologist, I have seen young men and women with a history of fractures at an early age, or with muscle aches, weakness, or atrophy. I always try to be sensitive to the fact that anorexia or bulimia can cause bone and musculoskeletal complaints. Pop culture and social media have long pressured people, especially children and young adults, to be 'thin and have the perfect body.' I want to teach young girls to love their bodies, be healthy, and achieve a healthy weight and body mass index (BMI) for their height.
What happens with eating disorders? People with eating disorders become malnourished, and the body responds to hormonal signals sent to compensate for lost nutrients. Estrogen levels decrease, resulting in loss of menstrual periods, a cooler core body temperature, and a slower heart rate. In children and young women, estrogen loss reduces bone production and bone strength. The brain also reacts to starvation by signaling the adrenal glands to secrete cortisol, which further accelerates bone loss. Adolescents and young adults with anorexia can develop early-onset osteoporosis and suffer non-traumatic fractures.
Complications of anorexia. Chronic anorexia can affect multiple organs and lead to anemia; kidney stones or kidney failure; thinning, brittle hair and nails; electrolyte imbalances (sodium, magnesium, potassium, calcium); difficulty swallowing; constipation, abdominal pain, and bloating; easy bruising; loss of menstrual periods (amenorrhea) and problems getting pregnant; palpitations and heart failure; low blood pressure and a slow heart rate; memory loss or brain fog, dizziness or fainting, and depression; weak muscles, swollen joints, and bone pain; and height loss, osteoporosis, and fractures.
Muscle wasting and atrophy occur when the body lacks the vitamins, protein, and fat it needs and starts feeding off itself. Abnormal potassium, sodium, and calcium levels can cause seizures and muscle weakness, since these electrolytes are crucial for sending electrical and chemical signals in the brain and muscles.
Complications of bulimia. Bulimia can cause depression, fear and anxiety about gaining weight, and low self-esteem; cavities, enamel erosion, and gum disease; bad breath; swollen salivary glands; gastric reflux and peptic ulcers; throat irritation; gastrointestinal bleeding from frequent vomiting; seizures from low blood sugar; knuckle abrasions; anemia; irregular heartbeat, low blood pressure, and slow heart rate; irregular bowel movements and periods; dehydration; and electrolyte loss (low potassium, magnesium, sodium).
Summary. People with either disorder can experience low self-esteem, anxiety, and depression related to body image, and exercise addiction can be seen. Bone pain and fractures result from bone mineral deficiencies, and damage to muscles and nerves from malnourishment can be detrimental.
Physicians can order tests to detect early bone loss, such as a DEXA scan (bone mineral density), serum estradiol, calcitonin, sodium, potassium, and magnesium levels, bone breakdown products, and type 1 collagen markers (carboxy-terminal propeptides and telopeptides).
Thank you to all the brave individuals who have shared their stories and experiences about this difficult topic. Although we don't often think about our bones, muscles, and joints until we're older, please recognize that certain disorders can affect the musculoskeletal system at an early age.
Dr. Maggie Cadet, MD