Eating and sleep disorders: bone loss in anorexia nervosa: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Eating and sleep disorders: bone loss in anorexia nervosa

Sample item

A 17-year-old with anorexia nervosa has a bone density scan showing osteopenia. Her parents ask what will best protect her bones. Which measure is most effective?

AA long-term combined oral contraceptive pillBHigh-dose vitamin D supplements aloneCOral bisphosphonate started immediatelyDWeight restoration with return of menstruation

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Weight restoration with return of menstruation

Bone loss in anorexia nervosa is driven by low weight, hypogonadism, raised cortisol and low IGF-1. Restoring weight and menses is the main treatment. Oestrogen replacement does not restore bone mass in this setting, and bisphosphonates are avoided in young women because of teratogenicity concerns.

Option by option

A. A long-term combined oral contraceptive pill
The contraceptive pill produces withdrawal bleeds without correcting the underlying deficit and has not been shown to rebuild bone.
B. High-dose vitamin D supplements alone
Vitamin D helps calcium handling but cannot overcome starvation-driven bone loss.
C. Oral bisphosphonate started immediately
Bisphosphonates are not first-line in young women and persist in bone for years.
D. Weight restoration with return of menstruation (correct)
Correct. Weight and menstrual recovery address the cause and give the best bone outcome.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is D, Weight restoration with return of menstruation. Bone loss in anorexia nervosa is driven by low weight, hypogonadism, raised cortisol and low IGF-1.

Why is "A long-term combined oral contraceptive pill" not the answer?

The contraceptive pill produces withdrawal bleeds without correcting the underlying deficit and has not been shown to rebuild bone.

Why is "High-dose vitamin D supplements alone" not the answer?

Vitamin D helps calcium handling but cannot overcome starvation-driven bone loss.

Why is "Oral bisphosphonate started immediately" not the answer?

Bisphosphonates are not first-line in young women and persist in bone for years.

What concept does this question test?

It tests Eating and sleep disorders: bone loss in anorexia nervosa in Psychiatry. Restoring weight and menses is the main treatment. Oestrogen replacement does not restore bone mass in this setting, and bisphosphonates are avoided in young women because of teratogenicity concerns.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Eating and sleep disorders: bone loss in anorexia nervosa?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.