Which of the following is not a direct consequence of bulimia nervosa?

Osteoporosis is not considered a direct consequence of bulimia nervosa because it typically arises from chronic nutritional deficiencies and prolonged lack of essential nutrients, often associated with prolonged periods of malnutrition or conditions such as anorexia nervosa rather than bulimia nervosa. While individuals with bulimia may experience nutritional imbalances due to erratic eating patterns, the specific behaviors associated with bulimia—such as binge eating followed by purging—are more directly linked to acute medical issues rather than long-term bone density loss.

In contrast, conditions like hypophosphatemia, swollen parotid glands, and Mallory-Weiss tears are direct sequelae of the recurrent vomiting and extreme dietary restrictions often seen in bulimia nervosa. Hypophosphatemia can occur due to electrolyte imbalances from frequent vomiting. The swollen parotid glands result from the strain of purging and can be a visible sign of the disorder. Lastly, Mallory-Weiss tears, which are tears in the mucosa at the junction of the stomach and esophagus, can happen due to the forceful vomiting associated with bulimia. Each of these conditions is directly related to the physiological effects of bulimia, distinguishing them from osteoporosis, which has a more complex etiology