Figure 2.

Bone mineral density (BMD) Z-scores of whole body less head (WBLH), lumbar spine (spine), and total hip skeletal sites across tested low-weight severity schemes in participants with Anorexia Nervosa (AN) and healthy controls (C).

Panel 1: BMD Z-scores based on severity of malnutrition classified according to absolute body mass index (BMI: kg/m²) (DSM-5/WHO BMI severity categories). BMD Z-scores at all sites are lower in AN participants with absolute BMI <15 (extreme), 15–15.99 (severe), 16–16.99 (moderate) and ≥17 (mild) compared to controls. AN participants with severe malnutrition (BMI 15–15.99) have lower total hip BMD Z-scores than those with moderate (BMI 16–16.99) and mild (BMI ≥17) malnutrition. *p<0.05.

Panel 2: BMD Z-scores, based on severity of malnutrition classified according to percent median BMI (%mBMI) as suggested by the Society for Adolescent Health and Medicine (SAHM). BMD Z-scores at the lumbar spine and total hip are lower in anorexia nervosa (AN) participants at <80% (moderate and severe), 80–90% (mild) and >90% mBMI than controls, and at the WBLH in AN participants <80% (moderate and severe) and 80–90% (mild) than controls. AN participants with moderate/severe malnutrition (<80% mBMI) have lower lumbar spine BMD Z-scores than participants with mild malnutrition (>80–90% mBMI). *p<0.05.

Panel 3: BMD Z-scores, based on severity of malnutrition classified according to BMI Z-scores (SAHM). BMD Z-scores at all sites are lower in AN participants with BMI Z-scores ≤ −3 (severe), between −2 to −2.9 (moderate) or between −1 to −1.9 (mild) malnutrition compared to controls, and at the lumbar spine and total hip in AN participants with BMI Z-scores >−1 compared to controls. AN participants with severe malnutrition (BMI Z-scores ≤ −3) have lower lumbar spine and total hip BMD Z-scores than those with mild malnutrition (BMI Z-scores between −1 to −1.9) and AN participants with BMI Z-scores >−1. *p<0.05.