Case Report: Osteoporosis as a Complication of Chronic Anorexia Nervosa in a Male

Mr P. is a 38-year-old, single, unemployed, Caucasian man with a 23-year history of anorexia nervosa. Throughout his illness he has controlled his weight predominantly by restricting his calorie intake. He also shows obsessional features when eating; cutting food into very small pieces and showing deliberate slowness over chewing, swallowing and ®nishing meals. He exercises by walking briskly for 1±2 h/day. He has never induced vomiting or used laxatives. Mr P. also has an obsessional fear of contamination with `germs' which leads to compulsive hand-washing up to 60 times a day. He was ®rst admitted to a medical ward, aged 15, after he collapsed at school as a result of extreme weight loss. Since then he has eight admissions because of severe weight loss. In the early years of his illness he was extensively investigated medically without any organic cause for his loss of weight being found. When he was 22 years old a leucotomy was performed in an unsuccessful attempt to control his obsessional compulsive symptoms. At 35 years old he had his ®rst grand mal seizure and his epilepsy has been reasonably controlled on carbamazepine alone since then. During his last hospital admission Mr P. complained of mild lower back pain which was relieved by paracetamol. He could not recall any recent trauma to his back or the exact onset of the pain. An X-ray of his lumbar spine was taken as a precaution. This revealed an anterior wedge fracture of the ®rst lumbar vertebra with appearances consistent with recent collapse. A