Can Anxiety or Depression Determine Low BMD in Patients With Anorexia?

Both anxiety and depression scores are associated with low BMD.
This article is part of Endocrinology Advisor’s coverage of the 2017 American Society for Bone and Mineral Research (ASBMR) Annual Meeting taking place in Denver, CO. Check back regularly for more news on the latest clinical research in bone health from ASBMR 2017.

Although anxiety and depression are not significant determinants of low bone mineral density (BMD), scores for both anxiety and depression are associated with low BMD, according to a study presented at the American Society for Bone and Mineral Research (ASBMR) 2017 Annual Meeting, held September 8-11 in Denver, Colorado.

A study conducted by Julia Herrou, PhD, of the rheumatology department at Cochin Hospital in Paris, France, and colleagues evaluated anxiety, depression, and obsessive-compulsive symptoms (OCs) in patients with anorexia nervosa (AN). The researchers assessed the relationships of depression and anxiety with low BMD in patients hospitalized with severe AN, as well as BMD changes after hospitalization.

The study included 220 women with severe AN who were admitted as inpatients for treatment at 11 centers across France between 2009 and 2011. Investigators used psychometric scales to measure anxiety, depression, and OCs, and BMD was measured during the hospitalization with dual-energy X-ray absorptiometry (DXA) and at 1 year after discharge with centralized analysis.

Low BMD was defined by a Z score less than or equal to -2; BMD gain was defined as an increase in the BMD of 0.03 g/cm² at spine or hip sites.

At hospital admission, 75% of the patients had depression, with 36% receiving antidepressant treatment. There were 67% with an overall poor global clinical status according to the Morgan and Russell Global Outcome Score (GOAS) and 52% with low BMD, identifying a “significant association” between GOAS scores and low BMD (odds ratio [OR]: 0.81; 95% CI, 0.67-0.97; P =.02). A trend for an association between low BMD and bone density index (BDI) was also noted (P =.06). Lifetime lowest weight was the single determinant significantly associated with low BMD (OR=1.172; 95% CI, 1.04-1.33; P =0.008).

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At 1-year follow-up, 56 patients were available for study. A significant increase in BMD was noted in 45% of these patients. The researchers found no association between depression or anxiety scores at admission and gain in BMD in univariate and multivariate analyses.

“This study confirms that half of a population of females with severe AN has a low BMD,” Dr Herrou and colleagues concluded.  “There is a trend for an association between depression and anxiety scores and low BMD, but these disturbances are not significant determinants of low BMD.”


Herrou J, Etcheto A, Kolta S, et al. Relationship between depression and anxiety and low bone mineral density in patients hospitalized with severe anorexia nervosa. Presented at:  American Society for Bone and Mineral Research (ASBMR) 2017 Annual Meeting; September 8-11, 2017; Denver, CO. Abstract SA0277.