International Journal of ED

Bone quality assessed by trabecular bone score in severe anorexia nervosa: A brief report

International Journal of Eating Disorders
By Ashlie Watters, PhD, MPH Philip S. Mehler, MD, FACP, FAED, CEDS Linda Fielding MD


Low bone mineral density (BMD) in anorexia nervosa (AN) leads to increased risk of fractures. Debate exists whether to medicinally treat young patients with AN based on abnormal dual-energy x-ray absorptiometry (DXA) scores or to weight restore and reassess when older. Trabecular bone score (TBS), a technology measuring bone quality, is used in conjunction with DXA. This report explores the potential additional value of TBS, in adults with severe AN, to augment the DXA diagnostic information.


Seventy-one DXA scans were reanalyzed to obtain TBS results from patients (mean age: 36.3 years). Differences in laboratory, anthropometric values and concomitant DXA measurements in relation to TBS results are reported.


For the cohort, mean body mass index (BMI) was 13.6 kg/m2 (SD: 2.1). The vast majority of patients had normal TBS with a mean of 1.395 (SD: 0.08) but, most patients (69%) had abnormal average DXA BMD Z-scores of -2.2 (SD: 1.2). The patients who also demonstrated degraded bone quality on TBS had significantly lower percent ideal body weight and elevated alkaline phosphatase compared to patients with normal TBS (p's < .05).


Low BMD treatment decisions in AN may be optimized by considering both DXA and TBS results.


DXA; TBS; anorexia nervosa; bone mineral density; bone quality; trabecular bone score.

Written by

Ashlie Watters, PhD, MPH

Dr. Ashlie Watters joined ACUTE in 2016 and serves at the Associate Research Scientist. Dr. Ashlie Watters is the Associate Research Scientist for ACUTE and it is her role to conduct evidence-based…
Written by

Philip S. Mehler, MD, FACP, FAED, CEDS

Dr. Philip Mehler, MD, FACP, FED, CEDS founded ACUTE at Denver Health, the country’s only designated Center of Excellence for those with the most extreme forms of eating disorders and…

ACUTE Earns Prestigious Center of Excellence Designation from Anthem
In 2018, the ACUTE Center for Eating Disorders & Severe Malnutrition at Denver Health was honored by Anthem Health as a Center of Excellence for Medical Treatment of Severe and Extreme Eating Disorders. ACUTE is the first medical unit ever to achieve this designation in the field of eating disorders. It comes after a rigorous review process.

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