Transdermal Estrogen in Women With Anorexia Nervosa: An Exploratory Pilot Study

Area of Science:

• Bone and Mineral Research
• Endocrinology
• Psychiatric Disorders

Background:

• Anorexia nervosa (AN) is associated with low bone mineral density (BMD) and increased fracture risk, partly due to elevated bone marrow adipose tissue (BMAT).
• Standard oral estrogen therapies are ineffective for increasing bone mass in women with AN, despite amenorrhea being common.

Purpose of the Study:

• To investigate the effects of transdermal estradiol plus levonorgestrel on BMD and BMAT in women with AN.
• To assess changes in bone turnover markers and other relevant biomarkers.

Main Methods:

• A 6-month, open-label study involving 11 women with AN.
• Transdermal estradiol (0.045 mg/day) plus levonorgestrel (0.015 mg/day) was administered.
• BMD was measured by DXA, BMAT by 1H-magnetic resonance spectroscopy, and bone turnover markers were analyzed at 3 and 6 months.

Main Results:

• Lumbar spine BMD increased by 2.0% and lateral spine BMD by 3.2% after 6 months (p < 0.05).
• Lumbar spine BMAT significantly decreased by 13.9% after 3 months (p = 0.046).
• Increases in lateral spine BMD correlated with decreases in C-terminal collagen cross-links (CTX) (p = 0.047).

Conclusions:

• Short-term treatment with transdermal physiologic estrogen effectively increases spine BMD in women with anorexia nervosa.
• Transdermal estrogen therapy may help mitigate bone loss in AN by reducing BMAT and bone resorption.