Effects of Oral Dehydroepiandrosterone on Bone Density in Young Women With Anorexia Nervosa: A Randomized Trial

Abstract

More than half of the patients with anorexia nervosa (AN) have early bone loss and fractures. Despite the usual marked estrogen deficiency in young women with AN, hormone replacement therapy (HRT) has given mixed results at best. Because subnormal dehydroepiandrosterone (DHEA) levels may contribute to bone loss in AN, this study compared a 12-month course of oral DHEA (50 mg daily) with conventional HRT (20 μg ethinyl estradiol plus 0.1 mg levonorgestrel) in 61 females with AN (age range, 14-28 years). Among 51 women completing the study, those in both treatment groups gained significant body weight and had increased lean body and fat mass. Regular bleeding was reported by 58% of those taking DHEA and 80% of the HRT group. Lumbar bone mineral density (BMD) did not change significantly, but BMD at the hip did increase and correlated positively with increasing body weight in both treatment groups (Fig. 1). Increased BMD also correlated with elevations in insulin-related growth factor I and bone-specific alkaline phosphatase, a marker of bone formation, but only in the DHEA group (Fig. 2). No substantial effect on BMD was evident after controlling for weight gain. Daily caloric intake decreased 10% in the HRT group and 15% in patients given DHEA. Psychological ratings, including measures of body image, eating attitudes, and anxiety, indicated improvement in the DHEA group only. It seems that DHEA has both anabolic and antiresorptive effects on bone in young women with AN and that it may be preferable to standard HRT, in part because of favorable psychological effects.