One of the most serious and potentially permanently disabling medical complications of anorexia nervosa is osteoporosis, which greatly increases the long-term risk of bone fractures. The decreased bone density in patients with anorexia nervosa (AN) is due to the many effects on bone metabolism of amenorrhea, reduced levels of insulin growth factor-1 (IGF-1), high cortisol levels and weight loss. Although estrogen replacement therapy is clearly efficacious in preventing postmenopausal osteoporosis, its efficacy in AN is uncertain.

 ABSTRACT: Grinspoon and colleagues (1) reported on predictive factors for osteopenia in anorexia nervosa. The accompanying editorial discussed potential pathophysiologic explanations that link body weight and bone mass (2). Previously, I and others reported that adipose tissue mass, even at low levels, regulates leptin levels in women with the restricting subtype of anorexia (3).

Bulimia nervosa (BN) is a prevalent illness. There are multiple different medical complications that impact the overall treatment plan and prognosis of these patients. Practitioners should be alert for medical complications that are a direct result of the mode of purging behavior utilized by the bulimic patient. The treatment will proceed most smoothly if the primary care physician and the mental health professional work collaboratively and have clear and frequent communication.

ABSTRACT: Anorexia nervosa is a psychiatric disorder characterized by abnormal eating behaviors that results in weight loss and has serious potential medical consequences. Most of these complications are readily treatable if diagnosed and attended to early in the course of the illness. In caring for patients with anorexia nervosa, the primary care physician has several critical roles. Because patients deny the severity of their illness, they delay seeking psychiatric treatment.

1. Mehler PS. “Medical Complications of Eating Disorders During Pregnancy.” In: Care of the Pregnant Patient ACP Press, Barbour L (ed.), Philadelphia; 2000.

Eating Disorders (e.g., anorexia nervosa and bulimia nervosa) are on the rise in our society and cause the highest mortality and medical morbidity of any psychiatric disorder. Medical complications of these two disorders are ubiquitous and can affect every system of the body. While the plight of an emaciated, malnourished patient (i.e., anorexic) is apparent by observation alone, diagnosis of bulimia can be more challenging.