Among the most severe sequelae of anorexia nervosa (AN) are its skeletal complications. Young women who have AN during adolescence may not attain their expected peak skeletal mass, and may enter adulthood with reduced bone mineral density (BMD) and an increased risk of fracture. This case history describes a young woman with severe AN that included prolonged exposure to both low body weight and amenorrhea. BMD measurement during the acute stage of her illness revealed severe osteopenia. Six years after recovery from AN, follow-up studies demonstrated only modest gains in BMD, with measurements for the hip and lumbar spine that are greater than 2 SDs below the age-matched mean.