Abstract
ABSTRACTAnorexia nervosa (AN) is a psychiatric disorder characterized by self‐induced starvation, low body weight, and elevated levels of bone marrow adipose tissue (BMAT). BMAT is negatively associated with BMD in AN and more than 85% of women with AN have low bone mass and an increased risk of fracture. Although a majority of women with AN are amenorrheic, which is associated with low BMD, oral contraceptive pills, containing supraphysiologic doses of estrogen, are not effective in increasing bone mass. We performed a 6‐month, open‐label study of transdermal estradiol (0.045 mg/day) + levonorgestrel (0.015 mg/day) in 11 women with AN (mean age ± SEM: 37.2 ± 2.3 years) to investigate the effects of transdermal, physiologic doses of estrogen on BMD and BMAT in women with AN. We measured change in BMD by DXA, change in BMAT at the spine/hip by 1H‐magnetic resonance spectroscopy, and change in C‐terminal collagen cross‐links (CTX), P1NP, osteocalcin, IGF‐1, and sclerostin after 3 and 6 months of transdermal estrogen. Lumbar spine (2.0% ± 0.8%; p = 0.033) and lateral spine (3.2% ± 1.1%; p = 0.015) BMD increased after 6 months of transdermal estrogen. Lumbar spine BMAT decreased significantly after 3 months (−13.9 ± 6.0%; p = 0.046). Increases in lateral spine BMD were associated with decreases in CTX (p = 0.047). In conclusion, short‐term treatment with transdermal, physiologic estrogen increases spine BMD in women with AN. Future studies are needed to assess the long‐term efficacy of this treatment. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
Highlights
A norexia nervosa, a psychiatric disorder predominantly affecting women, is characterized by an inappropriately low body weight caused by self-induced starvation
Subjects were a mean of 76.2% 2.1% of ideal body weight and had anorexia nervosa for a median of
bone marrow adipose tissue (BMAT), a possible determinant of low bone mass, decreases in response to estrogen replacement in this population. These data suggest that physiologic, transdermal estrogen replacement should be further studied as a possible treatment for low bone mass in adult women with anorexia nervosa
Summary
A norexia nervosa, a psychiatric disorder predominantly affecting women, is characterized by an inappropriately low body weight caused by self-induced starvation. Of women with this disorder have low bone mass,(1) which is associated with a significantly increased risk of fracture.[2,3]. Duration of amenorrhea is associated with low BMD in women with anorexia nervosa[5]; hypoestrogenemia is an important potential determinant of low bone mass in this population. Despite retrospective studies suggesting a potential beneficial effect of oral estrogen on bone in anorexia nervosa,(5) prospective and randomized, placebocontrolled studies have shown that oral estrogen, predominantly in the form of oral contraceptive pills that contain supraphysiologic doses of estrogen, does not increase BMD in women with anorexia nervosa.[6,7,8,9].
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