To the Editor.
—The study by Rencken and colleagues1 raises additional concerns about the detrimental effects of amennorhea in female athletes. Another population of young females for whom a similar concern is warranted includes those individuals who have anorexia nervosa.This disorder is characterized by abnormally low nutrient intake, refusal to maintain body weight at or above 85% of normal weight, intense fear of weight gain, and amenorrhea of at least 3 months' duration.2 The prevalence of anorexia nervosa is 1% to 4% among adolescent females and college-age women and seems to be increasing; only about 50% of patients recover completely.3Osteoporosis recently has been added to the growing list of medical complications associated with anorexia nervosa. Pathologic fractures of the hip, spine, and long bones have been reported in these patients. These often occur early in the course of anorexia in adolescent girls, presumably because
Mehler PS. Bone Density in Amenorrheic Athletes and in Anorexia Nervosa. JAMA. 1996;276(17):1384. doi:10.1001/jama.1996.03540170028017