Increased prevalence of lower extremity soft tissue injuries and surgeries in patients with anorexia nervosa and bulimia nervosa

ABSTRACT

Purpose

An abundance of literature exists linking eating disorders and fracture risk. However, no studies, to our knowledge, have investigated the impact of eating disorders on lower extremity soft tissue injury or surgery risk. The purpose of this study was to determine if anorexia nervosa and bulimia nervosa are associated with prevalence of lower extremity soft tissue injuries and surgeries.

Methods

Patients with anorexia nervosa or bulimia nervosa over 2010–2020 were identified through the International Classification of Diseases (ICD) codes in the PearlDiver Claims Database. Patients were matched by age, gender, comorbidities, record dates, and region to control groups without anorexia or bulimia. Soft tissue injuries were identified through ICD codes, and surgeries were identified through Current Procedural Terminology codes. Differences in relative prevalence were analyzed using chi-square analysis.

Results

Patients with anorexia had a significantly increased prevalence of meniscus tears (RR = 1.57, CI 1.22–2.03, p = 0.001) or deltoid ligament sprains (RR = 1.83, CI 1.10–3.03, p = 0.025), and patients with bulimia had a significantly increased prevalence of meniscus tears (RR = 1.98, CI 1.56–2.51, p < 0.001), medial collateral ligament sprains (RR = 3.07, CI 1.72–5.48, p < 0.001), any cruciate ligament tears (RR = 2.14, CI 1.29–3.53, p = 0.004), unspecified ankle sprains (RR = 1.56, CI 1.22–1.99, p < 0.001), or any ankle ligament sprains (RR = 1.27, CI 1.07–1.52, p = 0.008). Patients with anorexia had a significantly increased prevalence of anterior cruciate ligament reconstructions (RR = 2.83, CI 1.12–7.17, p = 0.037) or any meniscus surgeries (RR = 1.54, CI 1.03–2.29, p = 0.042), and patients with bulimia had a significantly increased prevalence of partial meniscectomies (RR = 1.80, CI 1.26–2.58, p = 0.002) or any meniscus surgeries (RR = 1.83, CI 1.29–2.60, p < 0.001).

Conclusions

Anorexia and bulimia are associated with increased prevalence of soft tissue injuries and surgeries. Orthopedic surgeons should be aware of this risk, and patients presenting to clinics should be informed of the risks associated with these diagnoses and provided with resources promoting recovery to help prevent further injury or surgery.

KEYWORDS:

• Sports medicine
• orthopedic surgery
• soft tissue injuries
• eating disorders
• knee injuries
• ankle injuries

Disclosure statements

The authors report there are no competing interests to declare.

Ge oloca tion Inf orma tion

The data used in this study are derived from patients in the United States. The work was performed at the Johns Hopkins University School of Medicine and the George Washington University School of Medicine and Health Sciences.

Data availability statement

The data used in this study are available from the authors by reasonable request.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00913847.2023.2237988

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.