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Does hormone replacement normalize bone geometry in adolescents with anorexia nervosa?
Amy D DiVasta1, Henry A Feldman, Thomas J Beck
1Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Division of Pediatric and Adolescent Gynecology, Boston Children's Hospital, Boston, MA, USA.
Summary
Hormone replacement therapy with dehydroepiandrosterone (DHEA) plus combined oral contraceptives (COC) improved bone geometry and strength in young women with anorexia nervosa (AN). This treatment stabilized bone mineral density, unlike placebo, offering a promising intervention for skeletal deficits in AN patients.
Area of Science:
- Endocrinology
- Bone Metabolism
- Reproductive Health
Background:
- Young women with anorexia nervosa (AN) experience hormonal deficiencies, including reduced dehydroepiandrosterone (DHEA) and estrogen.
- These deficiencies contribute to significant skeletal deficits and increased fracture risk in this population.
- Current treatment strategies for AN often do not adequately address bone health complications.
Purpose of the Study:
- To investigate the effects of oral DHEA plus combined oral contraceptive (COC) therapy versus placebo on bone geometry in young women with AN.
- To assess the impact of this hormone replacement therapy on surrogate measures of bone strength.
Main Methods:
- A randomized, double-blind, placebo-controlled trial involving 80 women with AN (aged 13-27 years) over 18 months.
- Participants received either micronized DHEA (50 mg/day) + COC or placebo.
- Bone mineral density (BMD), cross-sectional area (CSA), and section modulus were measured using dual-energy X-ray absorptiometry and Hip Structural Analysis (HSA).
Main Results:
- DHEA + COC treatment stabilized femoral shaft BMD, whereas the placebo group showed significant decreases.
- Improvements were observed in CSA, section modulus, and cortical thickness in the DHEA + COC group.
- The combination therapy demonstrated a beneficial impact on surrogate measures of bone strength, not solely bone density.
Conclusions:
- Adrenal and gonadal hormone replacement with DHEA + COC improves bone health and cross-sectional geometry in young women with AN.
- This combination treatment positively impacts surrogate measures of bone strength, offering a potential therapeutic strategy for skeletal complications in AN.
- Further research is warranted to explore long-term effects and clinical fracture outcomes.
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