This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Golden, N. H. Articles by Shenker, I. R. Search for Related Content PubMed PubMed Citation Articles by Golden, N. H. Articles by Shenker, I. R. Related Collections Neuroendocrinology and Pituitary Calcium and Bone Metabolism Female Endocrinology

Alendronate for the Treatment of Osteopenia in Anorexia Nervosa: A Randomized, Double-Blind, Placebo-Controlled Trial

Divisions of Adolescent Medicine (N.H.G., E.A.I., M.S.J., W.M., J.S., I.R.S.), Pediatric Endocrinology (D.C.), and Child Psychiatry (S.H.), Schneider Children’s Hospital, New Hyde Park, New York 11040; and North Shore-Long Island Jewish Health System (N.H.G., E.A.I., M.S.J., D.C., S.H., I.R.S.), Albert Einstein College of Medicine, Bronx, New York 10461

Address all correspondence and requests for reprints to: Dr. Neville H. Golden, Division of Adolescent Medicine, Schneider Children’s Hospital, 410 Lakeville Road, Suite 108, New Hyde Park, New York 11040. E-mail: golden{at}lij.edu.

Osteopenia is a serious medical complication of anorexia nervosa, with no known effective treatment. We conducted a double-blinded, randomized trial comparing alendronate (10 mg daily) with placebo in 32 adolescents with anorexia nervosa (mean age, 16.9 ± 1.9 yr). All subjects received 1200 mg elemental calcium and 400 IU vitamin D daily and received the same multidisciplinary treatment for their eating disorder. Bone mineral densities (BMDs) of the lumbar spine and femoral neck were measured by dual energy x-ray absorptiometry at baseline and after 1 yr of treatment. Twenty-nine subjects completed the study. Femoral neck and lumbar spine BMDs increased 4.4 ± 6.4% and 3.5 ± 4.6% in the alendronate group compared with increases of 2.3 ± 6.9% and 2.2 + 6.1% in the control group (P = 0.41, femoral neck; P = 0.53, lumbar spine). From baseline to follow-up, BMD increased significantly at the femoral neck (P = 0.02) and lumbar spine (P = 0.02) in those receiving alendronate, but did not increase in those assigned placebo (P = 0.22, femoral neck; P = 0.18, lumbar spine). At follow-up, body weight was the most important determinant of BMD. BMD was significantly higher in subjects who were weight-restored compared with those who remained at low weight (P = 0.002, femoral neck; P = 0.04, lumbar spine). After controlling for body weight, treatment group assignment still had an independent effect at the femoral neck. We conclude that in adolescents with anorexia nervosa, weight restoration is the most important determinant of BMD, but treatment with alendronate did increase the BMD of the lumbar spine and femoral neck within the group receiving alendronate, but not compared with placebo in the primary analysis. Until additional studies have demonstrated efficacy and long-term safety, the use of alendronate in this population should be confined to controlled clinical trials.

This article has been cited by other articles:

				K. J. Loud and C. M. Gordon Adolescent bone health. Arch Pediatr Adolesc Med, October 1, 2006; 160(10): 1026 - 1032. [Abstract] [Full Text] [PDF]

				J. Yager, M. J. Devlin, K. A. Halmi, D. B. Herzog, J. E. Mitchell, P. S. Powers, and K. J. Zerbe Eating Disorders Focus, October 1, 2005; 3(4): 503 - 510. [Abstract] [Full Text] [PDF]

				S. M. Ott Letter re: Alendronate in Anorexia Nervosa J. Clin. Endocrinol. Metab., September 1, 2005; 90(9): 5508 - 5508. [Full Text] [PDF]

				N. H. Golden Authors' Response: Alendronate in Anorexia Nervosa J. Clin. Endocrinol. Metab., September 1, 2005; 90(9): 5508 - 5508. [Full Text] [PDF]