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Physiologic estrogen replacement increases bone density in adolescent girls with anorexia nervosa
Author(s) -
Misra Madhusmita,
Katzman Debra,
Miller Karen K,
Mendes Nara,
Snelgrove Deirdre,
Russell Melissa,
Goldstein Mark A,
Ebrahimi Seda,
Clauss Laura,
Weigel Thomas,
Mickley Diane,
Schoenfeld David A,
Herzog David B,
Klibanski Anne
Publication year - 2011
Publication title -
journal of bone and mineral research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.882
H-Index - 241
eISSN - 1523-4681
pISSN - 0884-0431
DOI - 10.1002/jbmr.447
Subject(s) - medicine , estrogen , bone mineral , placebo , anorexia nervosa , endocrinology , amenorrhea , bone density , bone age , peak bone mass , randomized controlled trial , hormone replacement therapy (female to male) , osteoporosis , testosterone (patch) , pregnancy , eating disorders , biology , alternative medicine , pathology , psychiatry , genetics
Anorexia nervosa (AN) is prevalent in adolescents and is associated with decreased bone mineral accrual at a time critical for optimizing bone mass. Low BMD in AN is a consequence of nutritional and hormonal alterations, including hypogonadism and low estradiol levels. Effective therapeutic strategies to improve BMD in adolescents with AN have not been identified. Specifically, high estrogen doses given as an oral contraceptive do not improve BMD. The impact of physiologic estrogen doses that mimic puberty on BMD has not been examined. We enrolled 110 girls with AN and 40 normal‐weight controls 12 to 18 years of age of similar maturity. Subjects were studied for 18 months. Mature girls with AN (bone age [BA] ≥15 years, n = 96) were randomized to 100 µg of 17β‐estradiol (with cyclic progesterone) or placebo transdermally for 18 months. Immature girls with AN (BA < 15 years, n = 14) were randomized to incremental low‐dose oral ethinyl‐estradiol (3.75 µg daily from 0 to 6 months, 7.5 µg from 6 to 12 months, 11.25 µg from 12 to 18 months) to mimic pubertal estrogen increases or placebo for 18 months. All BMD measures assessed by dual‐energy X‐ray absorptiometry (DXA) were lower in girls with AN than in control girls. At baseline, girls with AN randomized to estrogen (AN E + ) did not differ from those randomized to placebo (AN E–) for age, maturity, height, BMI, amenorrhea duration, and BMD parameters. Spine and hip BMD Z ‐scores increased over time in the AN E+ compared with the AN E– group, even after controlling for baseline age and weight. It is concluded that physiologic estradiol replacement increases spine and hip BMD in girls with AN. © 2011 American Society for Bone and Mineral Research