Bone Density in Amenorrheic Athletes and in Anorexia Nervosa-Reply

In Reply.  —Dr Mehler's letter draws attention to one of the many medical consequences of anorexia nervosa: the loss of bone mass. This decrease in bone parallels that observed in amenorrheic athletes, and low body weight and inadequate endogenous estrogen are similar in both groups. However, it is important to note that amenorrheic athletes may lose bone in the absence of an eating disorder. Amenorrhea in athletes often can be attributed to failing to meet the energy requirement of their training rather than having anorexia nervosa. The athletes in our study consumed an equal amount of calcium as the eumenorrheic control athletes. In addition, a registered dietitian screened the athletes and ruled out those thought to have an eating disorder.As Mehler notes, several potential variables contribute to bone loss in anorectic women, thus creating challenges for determining the best therapeutic approach. Bone loss among amenorrheic athletes is associated with fewer factors,