Jackie Evancho, 22, Has Osteoporosis from Anorexia — Here's How the Two Conditions Are Linked

Christina Turino

America's Got Talent alum Jackie Evancho revealed in the new issue of PEOPLE that she has the "bones of an 80-year-old" caused by anorexia-induced osteoporosis.

The singer, 22, has been battling anorexia since she was a teenager, but it took a car accident that resulted in two "abnormal" breaks in her back to make her realize she needed help.

"That's how I learned that my eating problems created osteoporosis," she told PEOPLE. "So now I'm a 22-year-old with osteoporosis."

How can the bones of a young person be so damaged by an eating disorder?

"About 40% of individuals with eating disorders have some signs of osteoporosis," says Dr. Susan Albers, a clinical psychologist who specializes in eating disorders at Cleveland Clinic. "It's caused by a decrease in nutrition, specifically calcium and vitamin D."

RELATED: Jackie Evancho, 22, Reveals She Has Bones of an '80-Year-Old' Due to Anorexia-Caused Osteoporosis

But estrogen is also a significant factor in the development of osteoporosis, she adds — especially for teenagers. "If you have anorexia and you're not getting nutrition, your period tends to stop and your estrogen level drops, which is critical for the development of bone density."

That's what makes bones less dense and more likely to fracture, she explains, pointing to Evancho's breaks from the accident.

"One of the things that's really highlighted by her story is that it happens very silently, and it's something that you can't observe," Albers says. "People are very shocked and unaware of what is happening inside."

Albers, who did not treat Evancho, adds that because the singer's disordered eating began when she was 15, it likely contributed to the severity of her bone density issues. "The younger you are when this develops, the more of a long-lasting impact it has on your bone density," Albers says.

But there are ways to lessen the severity of the condition.

RELATED: AGT's Jackie Evancho on the Dark Side of Child Stardom: 'There Were Men Who Wanted to Hurt Me'

"If there are initial signs — fractures, stunted growth, losing inches or height — ask your doctor for a bone mineral density scan," Albers says. "If you catch it at this stage, you can increase your calcium, and also your vitamin D, which is critical for absorbing the calcium."

Ultimately, she says, it's crucial to get your period on track. "Because if you're not getting your period, that estrogen is not going to be there."

She adds that there are also lifestyle changes that can help, including stress reduction, since the stress hormone cortisol impacts bone density. People can also exercise more, and should stop smoking.

"You can slow it down, and there may be medications that can help," she says. "But there's no cure. If it gets to the point of osteoporosis, a lot of the damage is already done."

That's why it's so crucial to get help for eating disorders early on.

"Someone can look great on the outside and be functioning well, but on the inside, the eating disorder can cause an enormous amount of damage. So if somebody is struggling with this, it's really important to reach out for help."