What measures are used to address osteopenia in anorexia nervosa?

• A. Calcium and Vitamin D supplementation
• B. Vitamin C
• C. Estrogen replacement
• D. Iron therapy

Answer: (A)

Osteopenia in anorexia nervosa is driven by energy deficiency and hormonal changes that disrupt bone remodeling. The most appropriate initial measure to address this is replenishing calcium and vitamin D, since these nutrients are essential for bone mineralization and are commonly deficient in individuals with malnutrition. Providing calcium supports the amount available for bone formation, while vitamin D improves calcium absorption and bone turnover, helping to slow further bone loss during recovery.

In contrast, vitamin C, while important for collagen production, does not directly correct bone mineral density. Estrogen replacement is not routinely used in young women with anorexia because it does not fix the underlying nutritional deficits and carries risks; it’s not the first-line approach to improving bone density in this context. Iron therapy targets anemia, not bone density.

So, calcium and vitamin D supplementation stands as the best measure to support bone health in this setting, paired with nutritional rehabilitation and weight restoration for long-term recovery.