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Bone marrow fat content in 70 adolescent girls with anorexia nervosa: Magnetic resonance imaging and magnetic resonance spectroscopy assessment

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Abstract

Background

Adolescents and women with anorexia nervosa have increased bone marrow fat and decreased bone formation, at least in part due to hormonal changes leading to preferential stem cell differentiation to adipocytes over osteoblasts.

Objective

The purpose of this study was to evaluate marrow fat content and correlate with age and disease severity using knee MRI with T1 relaxometry (T1-R) and MR spectroscopy (MRS) in 70 adolescents with anorexia nervosa.

Materials and methods

We enrolled 70 girls with anorexia nervosa who underwent 3-T knee MRI with coronal T1-W images, T1-R and single-voxel proton MRS at 30 and 60 ms TE. Metaphyses were scored visually on the T1-W images for red marrow. Visual T1 score, T1 relaxometry values, MRS lipid indices and fat fractions were analyzed by regression on age, body mass index (BMI) and bone mineral density (BMD) as disease severity markers. MRS measures included unsaturated fat index, T2 water, unsaturated and saturated fat fractions.

Results

All red marrow measures declined significantly with age. T1-R values were associated negatively with BMI and BMD for girls ≤16 years (P=0.03 and P=0.002, respectively) and positively for those≥17 years (P=0.05 and P=0.003, respectively). MRS identified a strong inverse association between T2 water and saturated fat fraction from 60 ms TE data (r=−0.85, P<0.0001). There was no association between unsaturated fat index and BMI or BMD.

Conclusions

The association between T1 and BMI and BMD among older girls suggests more marrow fat in those with severe anorexia nervosa. In contrast, the physiological association between marrow fat content and age remained dominant in younger patients. The strong association between T2 water and saturated fat may relate to the restricted mobility of water with increasing marrow fat.

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Article Open access 01 July 2023

Enisa Shevroja, Jean-Yves Reginster, … Nicholas C. Harvey

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Acknowledgments

This study was funded by R01 AR060829 from the National Institutes of Health, NIH UL1 RR-025758 (Harvard Clinical and Translational Science Center), and the Brown Alpert Medical School Department of Orthopaedics.

We thank Patricia T. Chang, M.D., Loma Linda University Medical Center, Loma Linda, CA, for her expert image review.

Author information

Authors and Affiliations

  1. Department of Radiology, Boston Children’s Hospital, 333 Longwood Ave., Boston, MA, 02115, USA

    Kirsten Ecklund, Sridhar Vajapeyam & Robert V. Mulkern

  2. Clinical Research Center, Boston Children’s Hospital, Boston, MA, USA

    Henry A. Feldman

  3. Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Jennifer M. O’Donnell

  4. Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA

    Amy D. DiVasta

  5. Division of Adolescent and Transition Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Catherine M. Gordon

Authors
  1. Kirsten Ecklund
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  2. Sridhar Vajapeyam
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  3. Robert V. Mulkern
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  4. Henry A. Feldman
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  5. Jennifer M. O’Donnell
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  6. Amy D. DiVasta
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  7. Catherine M. Gordon
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Correspondence to Kirsten Ecklund.

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Ecklund, K., Vajapeyam, S., Mulkern, R.V. et al. Bone marrow fat content in 70 adolescent girls with anorexia nervosa: Magnetic resonance imaging and magnetic resonance spectroscopy assessment. Pediatr Radiol 47, 952–962 (2017). https://doi.org/10.1007/s00247-017-3856-3

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  • DOI: https://doi.org/10.1007/s00247-017-3856-3

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