Anorexia and osteoporosis. Osteoporosis was not a term I had heard of until I became anorexic. When I was diagnosed with anorexia at the age of 19, I was told it was possible I would also have osteoporosis. I had heard other patients in the inpatient unit I was in at the time talk about anorexia and osteoporosis. I learnt about osteoporosis and what it was. Basically weak, fragile bones that break more easily. So when I was told that anorexia could result in me having osteoporosis was I worried? No. At the time, all that mattered to me was anorexia. Anorexia had made me want osteoporosis. It had convinced me that in order to be a ‘good enough’ anorexic, I had to have osteoporosis.
My first bone scan – 2008
I was sent for my first ever DEXA scan when I was an inpatient in this unit. It was my 20th birthday. I was provided with the results a few days later. I did not have osteoporosis. Was I relieved? No. I felt like I had failed. My psychiatrist said he was very surprised that I did not have osteoporosis, especially as I had been an athlete since a young teenager. He thought that the amount of impact my bones had experienced through training and competing, coupled with my lack of periods from the age of 14 and weight loss, would have made it a certainty that I had osteoporosis. But he was wrong. All the other patients in the unit had anorexia and osteoporosis. I did not have osteoporosis, so now I felt like I was not good enough at being anorexic.
My second bone scan – 2011
Fast forward three years to 2011. I was being discharged from my third (and last) inpatient admission. I was sent for another bone scan. The results were different this time. Now I had osteoporosis. So I had gone from having normal bone density in 2008 to having osteoporosis in 2011. My mindset had also changed in this time. In 2008, all that had mattered was anorexia. And I wanted to have osteoporosis to prove to anorexia that I was good enough.
But in 2011, I no longer wanted anorexia to rule my life. I wanted to start living. There was still a small part of me that felt satisfied to have osteoporosis because that belief that I needed it to prove my ‘anorexic worthiness’ from 2008 was still partly there. Anorexia and osteoporosis. I can’t have anorexia if I don’t have osteoporosis. But my large overwhelming feeling of being diagnosed with osteoporosis in 2011 was fear.
I was terrified of what having osteoporosis would mean for me. Would I be in a wheelchair by the age of 40? Would I break a bone at every stumble, or knock, or even hug? I was so frustrated with myself for ever thinking that I wanted osteoporosis. Anorexia and osteoporosis? I hated both of them.
I was put on medication. This included a calcium and vitamin D supplement, and alendronic acid. Alendronic acid is meant to help make your bones a bit stronger. So there I was at the age of 22 having to start taking medication that would normally only be needed for much older people. I was told that you can improve, or even reverse osteoporosis up to the age of 30. But after this, due to natural aging, your bones will not be able to get stronger.
In 2011, my T score in my spine was -2.7. Anything over -2.5 is osteoporosis. My hip was -2.0, which is osteopenia. Osteopenia is not quite as bad as osteoporosis. Anything from -1 to -2.5 is osteopenia. I was terrified that as my bones were already in this state, what would they be like in a few years time? Or even worse, in 10 or 20 years time.
My third bone scan – 2016
Over the nest few years, I took my medication as prescribed. I maintained my weight and did not break any bones, despite a few knocks and falls. When I went for my bone scan in 2016, my spinal T score was the same (-2.7), and my hip had marginally improved from -2 to -1.9. So despite five years of medication and trying to keep myself as well as I could, there had been no improvement. I still had osteoporosis. I was still terrified of what the future would be like. On the positive side, at least my scores had not deteriorated. The nurse said that improvement in scores is rare. She said that really the best you can hope for anyway is that you maintain your scores.
I had to stop taking alendronic acid. I had been taking it for five years and this was the maximum recommendation. So now the only ‘medication’ I was taking for my osteoporosis was calcium and vitamin D. I was convinced that my bones would now deteriorate.
My fourth bone scan – 2019
My next bone scan was in 2019. In 2016 I had started gaining a bit of weight. By 2019, I was about 6kgs heavier than I had been in 2016. I also started running again in 2016. I re-joined my old athletics club (which I wrote a blog about at the time which you can read here: Back on track https://www.bexquinlan.com/2016/06/back-on-track.html ) and started to train once a week. In 2019 I was 31. I was past the point of no return to improve osteoporosis, or so I’d been told. So I was not hopeful for my bone scan results. And whatever the results said, it was only going to be downhill from here on in as I was over 30.
My 2019 bone scan results were not what I had been expecting. My spinal T score had improved from -2.7 to -2.0. The T score for my hip had improved from -1.9 to -1.7. This meant that my spine was no longer in the osteoporosis category! Both my hip and my spine were in the osteopenia category. An improvement! I was very happy. The nurse was incredibly surprised. She said they never normally see people’s score actually improve. She was even more surprised that this had happened without the alendronic acid, without having periods, and with my age now tipping over 30. It was good progress.
I was still concerned about the future and the state of my bones. Given that I was now 31, it seemed inevitable that my bone strength would only get worse now. I just had to do my best to look after myself to try and slow that deterioration down as much as possible. The nurse suggested that there was now new medication that could help with building bone strength. I asked my doctor about going back on some sort of medication to help however, I was not allowed. He indicated that the new medications are still a form of alendronic acid and it was not recommended that I have more this. So I was to just continue with the calcium and vitamin D.
My fifth bone scan – 2021
I have just had my next bone scan. It was in August 2021. I am now nearly 33 and was convinced it would be a bad result. My bones have felt a bit weaker recently and I get many more aches and pains. I was terrified how severe my osteoporosis would have become. This is the most worried I had ever been for a bone scan.
I could not believe the results when I received them. My hip T score had improved from -1.7 to -1.1, and my spine T score had improved from -2.0 to -1.5. These were the biggest improvements I had ever had! My hip score of -1.1 is verging on the tip of normal. Far from deteriorating, my bone strength had massively improved. What had also improved was my mindset.
Several years ago, if I had received such improved scores, a part of me would still very much have felt that it meant I was not ‘ill enough’ with anorexia. Even though I had been worried what a future with osteoporosis would be like, there had always been that small part of me still feeling osteoporosis was needed to confirm my anorexia. But my 2021 bone scan was totally different. I would give anything to not have osteoporosis, and to never have had it in the first place.
Anorexia & Osteoporosis – My thoughts
The relief that I felt with my improved 2021 scores was overwhelming. I do not know exactly what it is that has caused my osteoporosis to improve like it did. Good nutrition and fuelling my body probably played an important role, along with starting weight training in 2019. Although I am uncertain of the exact causes for the improvements, there are two things I am certain of.
Firstly, it proves that being over 30 and having anorexia and osteoporosis is not a life sentence with guaranteed deterioration. The human body is incredible. And if we look after it as best we can, it can try to repair and heal. Secondly, anorexia will always try to convince you that you are not ill enough. There will always be symptoms, or BMI’s, or forms of treatment, or anything, that you won’t have had and which anorexia will use to make you believe that you have not been ill enough. The list really is endless. Anorexia will always find something, or many things, to have you believe that you are not good enough. That there are others “better” at anorexia than you, in a worse condition than you, and with a symptom that you don’t have.
My belief from years ago that I was not anorexic enough if I did not have osteoporosis is an example of this. Yes, I did end up developing osteoporosis. But it did that satisfy anorexia? Of course not. There was then something else that I needed to have to prove I had been ill enough. And did developing osteoporosis satisfy me? Hell no.
However, I now no longer feel I have to prove my anorexia or illness. But as I said earlier, a few years ago, I would have thought that my improved osteoporosis scores were evidence that I was not good enough and ill enough. But not anymore. Anorexia’s requirements regarding how ‘ill’ I am or what symptoms I have are no longer important to me. What is important is that I am able to live life as best I can. Because nothing will ever satisfy anorexia. But a fuller and better life will satisfy me.
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