Comparison of regional bone marrow adiposity characteristics at the hip of underweight and weight-recovered women with anorexia nervosa using magnetic resonance spectroscopy

Bone marrow adiposity (BMA) is an underestimated tissue, with properties that may alter bone strength especially in diseases that fragilize bone such as anorexia nervosa. In the present study, we investigated the regional characteristics of BMA at the hip of 40 underweight and 36 weight-recovered anorexic women, along with 10 healthy women, using magnetic resonance spectroscopy at multiple anatomical subregions (acetabulum, femoral neck, proximal femoral diaphysis and greater trochanter) to measure bone marrow fat fraction (BMFF) and apparent lipid unsaturation levels (aLUL). Correlations between BMFF, aLUL, body fat percentage (BF), and bone mineral density (BMD) at the femoral neck and total hip, both measured using dual-energy X-ray absorptiometry, were assessed in anorexic patients. Whereas BMFF was significantly higher and aLUL significantly lower at the femoral neck of underweight and weight-recovered patients compared to controls (BMFF: 90.1 +/- 6.7% and 90.3 +/- 7.5% respectively versus 81.3 +/- 8.1%; aLUL: 7.6 +/- 1.4% and 7.3 +/- 1.3% versus 9.2 +/- 1.5%), BMFF and aLUL were not significantly different between the 2 subgroups of patients. Besides, three noteworthy features were observed between BMA and the other measured parameters in anorexic patients. First, synergic alterations of BMA were observed at all sites, with an inverse relationship between BMFF and aLUL (rho = -0.88). Second, bone mineral compartment and BMA were associated, as a negative correlation between total hip BMD and BMFF was observed at all sites except the greater trochanter (rho = [-0.32;- 0.29]), as well as a positive correlation with aLUL at all sites except the proximal femoral diaphysis (rho = [0.25;0.37]). Finally, we found a positive correlation between BF and BMFF at the femoral neck (rho = 0.35), and a negative correlation between BF and aLUL at this same subregion (rho = -0.33), which suggest a complex relationship between BMA and BF. Overall, BMA possesses regional specificities which may impair bone health, even after weight recovering.