At every stage of life a nutritious, balanced diet promotes strong, healthy bones. A good diet includes sufficient calories and adequate protein, fat and carbohydrates, as well as vitamins and minerals – particularly vitamin D and calcium. In younger adults, a good diet helps to build bone mass and strength.

However, for people with anorexia nervosa (an eating disorder that affects both men and women) restrictive eating leads to malnourishment.

People who are malnourished have significantly lower than average bone density (quantity of bone that indicates bone strength) and are at an increased risk of developing osteoporosis at an early age.

For Dublin doctor, Ann Manley, her teenage anorexia caused osteoporosis at the age of 23. But it was a diagnosis of osteoporosis that helped her on the road to recovery from her eating disorder, while at the same time addressing her bone health before it was too late.

“My mother had been diagnosed a couple of years before me and I knew a lot about osteoporosis being a medical student at the time,” Dr Manley said.

“Actually, being diagnosed with osteoporosis made me realise that it wasn’t just my external appearance that was being affected by anorexia, it was my insides as well. And if my bones were affected who knows what else was going on inside my body.”

Dr Manley’s GP suggested a DXA scan, which proved that her eating disorder had done a great deal of damage.

“My bones were worse than my 70-year-old mother’s bones at the time. She had moderate osteoporosis and my bones were worse than that, I wasn’t expecting that. I thought my bone mass might have been a bit low but I didn’t expect full-blown osteoporosis. So I think that gave me the shock and incentive to actually turn things around and to start eating again,” she said.

Dr Manley is currently working as a hospital doctor in Waterford and hopes to become a specialist in old age medicine in the future.

Family history and genetics
Bone health is also largely dependent on genetics. Therefore, if a parent has osteoporosis their children are more susceptible to developing osteoporosis and fragile bones.

Dr Manley’s whole family had been diagnosed with osteoporosis, dramatically increasing her osteoporosis risk.

“I would have eventually developed osteoporosis more than likely because my sister has it, mother, aunts and granny have it,” she said. Her sister was diagnosed in her late 30s but her mother wasn’t diagnosed until the age of 68.

She would not have expected to be diagnosed at the age of 23, but her eating disorder had brought it on prematurely.

Osteoporosis in your 20s
People with anorexia have a low bone density, so many will go on to have fractures at a young age.

“Having osteoporosis in your 20s and 30s means a complete life change. I have broken ribs coughing, and I broke two bones in my foot while running for a bus,” Dr Manley said.
“You can’t play contact sport and you can’t go skiing. A lot of my friends at the time were playing tag rugby and there was a great social scene connected to that and if you are in your early 20s you want to be a part of it.
But with osteoporosis I couldn’t go near a tag rugby pitch.

“Now I do at least 30 minutes of walking a day, for both my bone health as well as my relaxation time – walking is a great de-stressor.”

At 29 years old, Dr Manley’s bones are almost back to normal density. But it has only been through recognising her eating disorder that has led to her bone recovery.

“My bones are almost back to normal now and recovering from anorexia has been the main step to improving my bone density,” she said.

“Eating properly, getting my periods back and taking calcium and vitamin D supplements – all of those things helped my bones.

“Obviously it was tough at the start, but with time I stopped over-exercising and started eating more. It took me a couple of years to really make the necessary changes.”

Dr Manley was also on the combined oral contraceptive pill for a number of years to raise oestrogen and to help get her hormones back on track.

Anorexia and bones
Anorexia has a number of consequences on the body that can lead to severe bone loss, including:

Low hormones
Most women with anorexia have low levels of oestrogen. Oestrogen protects bone density, and low levels can lead to a loss of menstrual periods.

Oestrogen deficiency in younger women contributes to bone loss in much the same way that oestrogen deficiency after menopause does.

Men with anorexia have very low testosterone levels, which also affects bone density.

Lack of nourishment
Because people with anorexia restrict their food intake, their bodies lack calories and protein. This leads to malnourishment, causing the body to produce high levels of the steroid cortisol, which affects bone density and scaffolding.

Lack of calcium
Calcium is the building block of bone. Most people with anorexia limit or exclude dairy products, resulting in calcium deficiency.

Lack of vitamin D
Low levels of vitamin D affects calcium absorption. It can also affect nerve and muscle function. Therefore, low vitamin D levels can indirectly increase bone loss.

A lot of people with anorexia also over-exercise which can lead to the body switching off female/male hormones.

The future
The best time in life to ensure bone health for the future is to start from childhood.
Exercise and good nutrition, with plenty of calcium-rich foods and enough regular sunshine to maintain vitamin D production, makes for strong bones.

However, most people think that osteoporosis only affects older people. Besides genetics and diseases, osteoporosis can affect people of all ages for different reasons.

“I think raising awareness is essential because if people know what osteoporosis is, then they know that it is preventable and treatable in most cases. I think this type of awareness may take the stigma away from osteoporosis,” she said.

One way Ireland is raising awareness, Dr Manley adds, is the introduction of osteoporosis education to the school curriculum.

Osteoporosis has been included in the home economics and biology syllabus for 2009/2010.

For more information on osteoporosis, click on

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