title: Does hormone replacement normalize bone geometry in adolescents with anorexia nervosa?
abstract: Young women with anorexia nervosa (AN) have reduced secretion of dehydroepiandrosterone (DHEA) and estrogen contributing to skeletal deficits. In this randomized, placebo-controlled trial, we investigated the effects of oral DHEA + combined oral contraceptive (COC) versus placebo on changes in bone geometry in young women with AN. Eighty women with AN, aged 13 to 27 years, received a random, double-blinded assignment to micronized DHEA (50 mg/day) + COC (20 µg ethinyl estradiol/0.1 mg levonorgestrel) or placebo for 18 months. Measurements of areal bone mineral density (aBMD) at the total hip were obtained by dual-energy X-ray absorptiometry at 0, 6, 12, and 18 months. We used the Hip Structural Analysis (HSA) program to determine BMD, cross-sectional area (CSA), and section modulus at the femoral neck and shaft. Each measurement was expressed as a percentage of the age-, height-, and lean mass-specific mean from an independent sample of healthy adolescent females. Over the 18 months, DHEA + COC led to stabilization in femoral shaft BMD (0.0 ± 0.5% of normal mean for age, height, and lean mass/year) compared with decreases in the placebo group (-1.1 ± 0.5% per year, p = 0.03). Similarly, CSA, section modulus, and cortical thickness improved with treatment. In young women with AN, adrenal and gonadal hormone replacement improved bone health and increased cross-sectional geometry. Our results indicate that this combination treatment has a beneficial impact on surrogate measures of bone strength, and not only bone density, in young women with AN.
authors.affiliation: Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Division of Pediatric and Adolescent Gynecology, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Amy D
authors.initials: AD
authors.lastname: DiVasta
authors.forename: Henry A
authors.initials: HA
authors.lastname: Feldman
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Beck
authors.forename: Meryl S
authors.initials: MS
authors.lastname: LeBoff
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Gordon
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000188:drug therapy* / Q000503:physiopathology; D015519:Bone Density / Q000187:drug effects*; D003277:Contraceptives, Oral, Combined / Q000627:therapeutic use*; D003687:Dehydroepiandrosterone / Q000627:therapeutic use*; D005260:Female; D005269:Femur / Q000033:anatomy & histology / Q000187:drug effects; D005272:Femur Neck / Q000033:anatomy & histology / Q000187:drug effects; D006615:Hip; D020249:Hormone Replacement Therapy; D006801:Humans
chemical_list: D003277:Contraceptives, Oral, Combined; D003687:Dehydroepiandrosterone
keywords: ADOLESCENTS; ANOREXIA NERVOSA; BONE GEOMETRY; DHEAS; ESTROGEN REPLACEMENT THERAPY