Effect on bone health of estrogen preparations in premenopausal women with anorexia nervosa: a systematic review and meta-analyses.
OBJECTIVE
Because estrogen therapies are widely prescribed for amenorrhea associated with anorexia nervosa (AN), we conducted a systematic review and meta-analyses to estimate the influence of estrogen preparations (EP) on bone mineral density in women with AN.


METHODS
Prospective cohort studies and randomized clinical trials (RCTs) comparing the effect of EP use to no treatment or placebo on bone mineral density and bone fractures were included. Independent reviewers selected studies for inclusion and extracted study characteristics, markers of methodologic quality, and outcomes for the intention-to-treat population.


RESULTS
Using random-effects meta-analyses and inconsistency across trials using the I(2) statistic, data were combined across two eligible prospective cohort studies and four RCTs; none reported effects on bone fractures. Compared with placebo or no treatment, low quality evidence found EPs have a moderate effect on bone mineral density in the lumbar spine [ES (effect size) 0.33, 95% CI (confidence interval) 0.09, 0.56; I(2) = 0%)], but no significant effect on the femoral neck (ES 0.13, 95% CI -0.16, 0.43; I(2) = 0%). There were no significant treatment-subgroup interactions.


CONCLUSIONS
In general, EPs have uncertain benefit and should be avoided by women with AN in whom the success of weight and nutritional rehabilitation is judged by menses resumption.
Department of Psychiatry and Psychology, Mayo Clinic, Minnesota, USA. sim.leslie@mayo.edu
Leslie A
LA
Sim
Lauren
L
McGovern
Mohamed B
MB
Elamin
Brian A
BA
Swiglo
Patricia J
PJ
Erwin
Victor M
VM
Montori
D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000188:drug therapy*; D015519:Bone Density / Q000187:drug effects*; D015331:Cohort Studies; D015914:Estrogen Replacement Therapy; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D017697:Premenopause / Q000187:drug effects*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D055815:Young Adult