title: The effect of gonadal and adrenal steroid therapy on skeletal health in adolescents and young women with anorexia nervosa.
abstract: Anorexia nervosa (AN) is characterized by subnormal estrogen and dehydroepiandrosterone (DHEA) levels. We sought to determine whether the combination of DHEA + estrogen/progestin is superior to placebo in preserving skeletal health over 18 months in AN. Females with AN, aged 13 to 27 years, were recruited for participation in this double-blind, placebo-controlled, randomized trial. Ninety-four subjects were randomized, of whom 80 completed baseline assessments and received either study drug (oral micronized DHEA 50 mg + 20 µg ethinyl estradiol/0.1 mg levonorgestrel combined oral contraceptive pill [COC] daily; n = 43) or placebo (n = 37). Serial measurements of areal bone mineral density (aBMD), bone turnover markers, and serum hormone concentrations were obtained. Sixty subjects completed the 18-month trial. Spinal and whole-body aBMD z scores were preserved in the DHEA + COC group, but decreased in the placebo group (comparing trends, P = .008 and P = .001, respectively). Bone turnover markers initially declined in subjects receiving DHEA + COC and then returned to baseline. No differences in body composition, adverse effects of therapy, or alterations in biochemical safety parameters were observed. Combined therapy with DHEA + COC appears to be safe and effective for preventing bone loss in young women with AN, whereas placebo led to decreases in aBMD. Dehydroepiandrosterone + COC may be safely used to preserve bone mass as efforts to reverse the nutritional, psychological, and other hormonal components of AN are implemented.
authors.affiliation: Division of Adolescent Medicine, Children's Hospital Boston, Boston, MA 02115, USA. amy.divasta@childrens.harvard.edu
authors.forename: Amy D
authors.initials: AD
authors.lastname: Divasta
authors.forename: Henry A
authors.initials: HA
authors.lastname: Feldman
authors.forename: Courtney
authors.initials: C
authors.lastname: Giancaterino
authors.forename: Clifford J
authors.initials: CJ
authors.lastname: Rosen
authors.forename: Meryl S
authors.initials: MS
authors.lastname: Leboff
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Gordon
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000188:drug therapy*; D001823:Body Composition / Q000187:drug effects; D015519:Bone Density / Q000187:drug effects; D001842:Bone and Bones / Q000187:drug effects* / Q000378:metabolism; D003277:Contraceptives, Oral, Combined / Q000097:blood / Q000627:therapeutic use; D003687:Dehydroepiandrosterone / Q000097:blood / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004967:Estrogens / Q000097:blood / Q000627:therapeutic use*; D004997:Ethinyl Estradiol / Q000097:blood / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016912:Levonorgestrel / Q000097:blood / Q000627:therapeutic use; D011372:Progestins / Q000097:blood / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D003277:Contraceptives, Oral, Combined; D004967:Estrogens; D011372:Progestins; D004997:Ethinyl Estradiol; D003687:Dehydroepiandrosterone; D016912:Levonorgestrel