Relationship of bone density to estradiol and cortisol in anorexia nervosa and bulimia.

Dual photon absorptiometry was used to assess the risk of developing osteoporosis in patients with anorexia nervosa and patients of normal weight with bulimia nervosa. Anorectic patients had significantly lower vertebral bone mineral densities compared with healthy controls. Bulimic patients had values similar to those of controls, and the differences between bulimics and anorectics narrowly missed significance. No significant difference was found between patient groups in measurements of serum estradiol, but anorectics, compared with bulimics, had significantly higher values of 24-hour urinary free cortisol. Hypercortisolemia, by diminishing bone formation and increasing bone resorption, is likely to contribute to the development of osteoporosis in patients with eating disorders.