Anorexia nervosa and risk of fractures: A matched cohort study of 80,000 men and women
Bibliographic record
Abstract
BACKGROUND: Anorexia nervosa is associated with an increased risk of fracture in women, but the association is unclear in men. We assessed the association between anorexia nervosa and the later risk of fracture hospitalization for men and women separately. METHODS: We performed a longitudinal cohort study of 7,332 patients with anorexia nervosa in Quebec, Canada, matched with 73,215 healthy controls between 1989 and 2023. The exposure was anorexia nervosa requiring inpatient treatment. Outcomes included severe fractures requiring admission for surgical reduction or fixation anytime after the anorexia nervosa admission. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of anorexia nervosa with risk of fracture hospitalization stratified by sex. RESULTS: Patients with anorexia nervosa had higher fracture rates than controls, including men (74.0 vs. 39.9 per 10,000 person-years) and women (47.6 vs. 21.0 per 10,000 person-years). Compared with matched controls, men with anorexia nervosa were 1.86 times more likely to be hospitalized for fractures (95% CI 1.34-2.58), while women were 2.26 times more likely (95% CI 2.02-2.51). Anorexia nervosa was associated with fractures of the femur, humerus, and thoracic/shoulder/pelvic bones. Anorexia nervosa was strongly associated with osteoporotic fractures (HR 7.50, 95% CI 5.62-10.01). CONCLUSION: Anorexia nervosa is associated with an increased risk of pathologic fractures up to 34 years later. The association is present for both men and women.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".