Bone health in avoidant/restrictive food intake disorder: a narrative review

An extensive body of evidence reports threatened bone health in people with eating disorders, focusing primarily on people with anorexia nervosa. The Diagnostic and Statistical Manual of Mental Disorders (DSM) Fifth Edition reclassified and expanded upon the DSM-IV diagnosis of “feeding disorder of infancy or early childhood,” introducing a new diagnostic term, avoidant/restrictive food intake disorder (ARFID). This has led to an increased need to understand effects of ARFID on bone health. Among the studies that have reported bone health outcomes in people with ARFID, authors have reported shorter stature and lower bone mineral density (BMD) in children and adults with ARFID compared to reference datasets. Malnutrition resulting in under-consumption of energy and/or nutrients that are integral to bone health can also cause conditions that impact the musculoskeletal system, including low body weight, scurvy due to vitamin C deficiency, and rickets due to vitamin D deficiency. Research in individuals with ARFID focusing on longitudinal changes in BMD, bone micro-structure, and bone strength during clinical intervention are required. These efforts will help identify long-term health risks in people with ARFID, inform comprehensive medical assessment, improve long-term health outcomes, and provide a benchmark for assessing treatment outcomes over time.