Seven years’ experience with etidronate in a woman with anorexia nervosa and vertebral fractures

Jun Iwamoto¹, Yoshihiro Sato², Mitsuyoshi Uzawa³, Tsuyoshi Takeda¹, Hideo Matsumoto^1
1Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan; ²Department of Neurology, Mitate Hospital, Fukuoka, Japan; ³Department of Orthopaedic Surgery, Keiyu Orthopaedic Hospital, Gunma, Japan

Abstract: We report the case of a 30-year-old Japanese woman with anorexia nervosa and vertebral fractures who was treated with etidronate. She had a history of anorexia nervosa, chronic back pain, osteoporosis, and multiple vertebral fractures (morphometric fractures) that responded poorly to treatment with alfacalcidol (1 µg daily) for 1 year and was treated with cyclical etidronate (200 mg for 2 weeks every 3 months) for 7 years. The lumbar spine bone mineral density (BMD) increased, and the serum alkaline phosphatase and urinary cross-linked N-terminal telopeptides of type I collagen levels and back pain decreased. During the 7-year period of treatment with etidronate, no osteoporotic fractures occurred. The patient experienced neither renal dysfunction nor hyperparathyroidism caused by osteomalacia. No gastrointestinal tract symptoms were observed. Thus, etidronate was effective for increasing the lumbar spine BMD and reducing back pain over a 7-year period without causing either osteoporotic fractures or adverse events.

Keywords: anorexia nervosa, bulimia, etidronate, bone mineral density, osteoporosis, vertebral fracture