Article :: Bone marrow changes in adolescent girls with anorexia nervosa

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Original Article

Bone marrow changes in adolescent girls with anorexia nervosa

Kirsten Ecklund¹, Sridhar Vajapeyam¹, Henry A Feldman^{2 5}, Catherine D Buzney³, Robert V Mulkern¹, Paul K Kleinman¹, Clifford J Rosen⁴, Catherine M Gordon^{3 5 *}

¹Department of Radiology, Children's Hospital Boston, Boston, MA, USA
²Clinical Research Program, Children's Hospital Boston, Boston, MA, USA
³Division of Adolescent/Young Adult Medicine, Children's Hospital Boston, Boston, MA, USA
⁴Department of Medicine, Maine Medical Center, Portland, ME, USA
⁵Division of Endocrinology, Children's Hospital Boston, Boston, MA, USA

email: Catherine M Gordon (catherine.gordon@childrens.harvard.edu)

^*Correspondence to Catherine M Gordon, Divisions of Adolescent Medicine and Endocrinology, Children's Hospital, 300 Longwood Ave., Boston, MA, USA.

Keywords

magnetic resonance imaging bone marrow fat relaxometry anorexia nervosa

Abstract

Early osteoporosis is common among adolescent girls with anorexia nervosa (AN) and may result from premature conversion of red (RM) to yellow bone marrow. We performed right knee magnetic resonance imaging (MRI) on a 1.0 T extremity scanner in 20 patients and 20 healthy controls, aged 16.2 ± 1.6 years (mean ± SD). Coronal T₁-weighted (T₁W) images and T₁ maps were generated from T₁ relaxometry images. Blinded radiologists visually assessed RM in the distal femoral and proximal tibial metaphyses in T₁W images using a scale of signal intensity from 0 (homogeneous hyperintensity, no RM) to 4 (all dark, complete RM). Subjects with AN exhibited nearly twofold lower metaphyseal RM scores in both the femur (0.64 versus 1.22, p = .03) and tibia (0.54 versus 0.96, p = .08). In relaxometric measurements of four selected regions (femur and tibia amd epiphysis and metaphysis), subjects with AN showed higher mean epiphyseal but lower metaphyseal T₁. The net AN-control difference between epiphysis and metaphysis was 70 ms in the femur (+31 versus -35 ms, p = .02) and of smaller magnitude in the tibia. In relaxometry data from the full width of the femur adjacent to the growth plate, AN subjects showed mean T₁ consistently lower than in controls by 30 to 50 ms in virtually every part of the sampling region. These findings suggest that adolescents with AN exhibit premature conversion of hematopoietic to fat cells in the marrow of the peripheral skeleton potentially owing to adipocyte over osteoblast differentiation in the mesenchymal stem cell pool. © 2010 American Society for Bone and Mineral Research

Received: 6 April 2009; Revised: 26 June 2009; Accepted: 30 July 2009

Digital Object Identifier (DOI)

10.1359/jbmr.090805 About DOI