Dehydroepiandrosterone status and efficacy of dehydroepiandrosterone supplementation for bone health in anorexia nervosa: A systematic review and meta‐analysis

Abstract

Objective This study was designed to determine the status of dehydroepiandrosterone (DHEA) in women with anorexia nervosa (AN) and to assess the efficacy of DHEA supplementation as a treatment for bone health in women with AN. Method Studies were retrieved from the PubMed, Embase, Cochrane Library, MEDLINE, and Scopus databases from inception to February 14, 2022. Observational studies that compared serum DHEA levels between women with AN and healthy controls were included for meta‐analysis, and randomized controlled trials (RCTs) that evaluated the effects of DHEA supplementation on bone mass were reviewed. Results Meta‐analysis of 15 cross‐sectional studies revealed that patients with AN had significantly elevated serum DHEA levels (mean difference (MD) = 311.63 ng/dl; 95% confidence interval (CI), 78.01–545.25) and reduced DHEAS levels (MD = −24.90 μg/dl; 95% CI, −41.72 to −8.07) compared with healthy controls. A systematic review of seven RCTs found that DHEA monotherapy does not improve bone mineral density (BMD) compared with placebo after adjusting for weight gain. While the combination of DHEA and conjugated oral contraceptives has led to increased bone strength and decreased bone loss, the beneficial effect appears to be limited to older adolescents and adults with closed physes. Potential detrimental effects on BMD were identified in younger adolescents with open physes in one study. Discussion Due to the lack of apparent benefit of DHEA in women with AN and its potential detrimental effect on BMD in young patients with AN, current evidence does not support the use of DHEA. Public Significance This study demonstrates that women with anorexia nervosa have abnormal levels of dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS), which have been suggested by previous studies to play a role in the development of low bone density in this condition. However, current evidence does not support the use of DHEA as a treatment to preserve bone health in patients with anorexia nervosa given the lack of clear benefit following its use and also because of a potential detrimental effect on bone mineral density in young patients with anorexia nervosa.

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“…However, previous studies on DHEA in blood samples in AN have obtained heterogeneous results, which may be in line with the null hypothesis. These results were summarized in a recently published review and meta-analysis [ 15 ]. The authors concluded that DHEA concentrations may be elevated in AN.…”

“…Previous research has reported decreased [ 9 , 10 ], elevated [ 11 , 12 ] as well as normal DHEA concentrations in blood samples [ 13 , 14 ]. However, a recently published meta-analysis of selected studies concluded that elevated blood levels of DHEA are present in AN [ 15 ]. The heterogeneity of the results of previous studies on DHEA may be partially explained by their relatively small sample sizes, risks of confounding bias (i.e., alcohol consumption, smoking, BMI) as well as the applied measurement methods based on blood, saliva, and urine samples.…”

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“…Obesity is a major problem throughout the world. Surveys consistently show that people are concerned by weight and its health related implications, and for that most individuals are making a concerted effort to either maintain or lose weight [3] .…”