Talking About Bone Density: Educational Tools Can Help Make the Point

As an educator, I am always looking for tools to help convey information to my clients. Individuals with eating disorders can present very specific challenges when it comes to education. As health professionals know, these clients can instantly refute even the clearest and most concise information. Even the most pressing health issues may be too abstract, too scary, or too real to break through the wall of denial. This is the ‘I can’t see it, I can’t feel it, therefore it isn’t happening’ syndrome. Even with a bone density scan in hand, the topic of bone mineral loss in anorexia can meet this fate.

Discussing bone density

How do I begin a discussion of bone density? I use images. For example, the 1998 summer issue of Scientific American Presents: Women’s Health: A Lifelong Guide1 contains exquisite color photographs of healthy and osteoporotic bone. These images demonstrate the powerful contrast between the strength of healthy bone and the fragility of osteoporotic bone.

With visuals in hand, I reach for my other tool—journal articles. Clients frequently want evidence, so I oblige them. For discussions about bone density, I find the review article Mechanisms and Treatment Options for Bone Loss in Anorexia Nervosa, by Steven Grinspoon MD, David Herzog MD and Anne Klibanski MD2, extremely helpful. With the patient, I review the article abstract, line by line. In clear language, the client can read the following important facts:

• “Osteoporosis is present in over half of all patients with anorexia nervosa.
• Bone loss often occurs at a young age and may persist after recovery…
• The pathogenesis of bone loss in anorexia is not completely understood, but may result from a number of different mechanisms, including estrogen deficiency, inadequate vitamin and calcium intake and nutritional effects on bone formation.
• In a majority of patients, estrogen itself is not enough to increase bone mineral density. Research suggests that nutritionally dependent factors such as insulin-like growth factor (IGF-I)…may be important in maintaining bone mass.
• Currently, weight gain, restoration of gonadal function, and calcium supplementation remain the cornerstones of treatment.”

As a dietitian, almost every aspect of denial that I encounter is addressed in this article. As the client and I read through the abstract, we refer to the paragraphs where each topic is addressed in detail. After we review the entire article, I give her a copy to keep.

— Tami J. Lyon, MPH, RD, CDE