Transdermal Estrogen in Women With Anorexia Nervosa: An Exploratory Pilot Study.
Megi ResulajSai P PolineniErinne MeenaghanKamryn EddyHang LeePouneh K FazeliPublished in: JBMR plus (2019)
Anorexia 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.
Keyphrases
- estrogen receptor
- anorexia nervosa
- bone mineral density
- body weight
- bone marrow
- adipose tissue
- open label
- bone loss
- mesenchymal stem cells
- insulin resistance
- body composition
- squamous cell carcinoma
- cell proliferation
- combination therapy
- magnetic resonance
- randomized controlled trial
- diabetic rats
- multidrug resistant
- computed tomography
- escherichia coli
- current status
- high glucose
- type diabetes
- klebsiella pneumoniae
- signaling pathway
- high fat diet
- oxidative stress
- locally advanced
- phase ii study
- phase iii
- double blind