Long-term physical morbidity is also common and serious. Growth retardation is present in some patients who have an early onset of disease. Anovular infertility is common in some women who have only partially recovered. Osteopaenia leading to osteoporosis is a serious complication of the active disease, but may also have long-term effects because bone mineralization in women terminates with the menopause. Those who have not accumulated sufficient bone in younger life are prone to developing osteoporosis with ageing earlier than their peers.
More women die as a result of a fractured femur than of breast cancer.
Renal and hepatic function are frequently permanently impaired by anorexia nervosa, and a neurogenic bowel with subsequent rectal prolapse is common, sometimes but not invariably associated with laxative abuse. The effects of the disease on the family are horrendous. Unfortunately, parents have been blamed for causing the disease in their offspring. Anorexia nervosa is often claimed to result from sexual abuse, but this is less common than alleged. As a result, parents are made to feel guilty.