Q & A: An Anorexic with Painful Shins

Reprinted from Eating Disorders Review
January/February 1999 Volume 10, Number 1
©1999 Gürze Books

Q: One of my patients with anorexia nervosa, a compulsive exerciser who runs about 3 hours per day, has been complaining about pain in her shins. However, the x-rays that her physician ordered show no fractures. (They do, however, show low bone density, which he has called osteopenia.) What can account for this? (B.B., San Francisco)

A: It’s very possible that even though your patient doesn’t have evidence for fractures on regular x-rays, she may still have stress fractures. Some research in patients with anorexia nervosa has shown that even when regular x-rays are normal, bone scans often reveal ncreased uptake in the affected areas, consistent with stress fractures (Arch Phys Med Rehabil 76: 884, 1995). The important points here are as follows: first, your patient should ask her physician to consider ordering a bone scan to examine the affected areas. Second, your patient should not interpret the lack of a clear-cut fracture on the ordinary x-ray as a license to continue exercising vigorously. Until the bone scans are performed, she should not engage in vigorous exercise. Finally, research suggests that whereas moderate intensity exercise of 4 to 6 hours per week may have a beneficial effect on bone density, it has not yet been demonstrated that whatever increase in bone density may occur offsets the increased risk of stress fractures. Some authorities believe that more strenuous exercise may actually aggravate the osteoporosis associated with anorexia nervosa.

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