Effect on bone health of estrogen preparations in premenopausal women with anorexia nervosa: A systematic review and meta‐analyses

Abstract

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.

Effects of Exercise on Bone Mass in Young Women with Anorexia Nervosa

“…Most of our participants reported OCP use, and their exclusion would have not only led to a substantial loss of statistical power but also resulted in a nonrepresentative sample, limiting generalizability of our results to a minority of women with AN. Currently, there is no evidence that OCP use has an effect on BMD in AN patients (35,46), and adjustment for OCP use did not change our results. However, we cannot rule out that OCP use may modify the effect of exercise on bone, and further study is needed to investigate this possibility.…”

“…Furthermore, although exercise recommendation in women with a history of AN must be provided with caution, if exercise during recovery is shown to enhance bone strength, further research is warranted to determine the optimal type, frequency, and intensity of exercise and to identify patients for whom exercise might be particularly beneficial, such as those with the lowest BMD. As response to honnonal therapies seem limited in AN (35,46) and concerns about potential teratogenicity of bisphosphonate use in women of reproductive age persist, modification of excessive moderate-type exercise during illness and appropriate exercise prescription during recovery may provide an important nonpharmacological approach to osteoporosis management and fracture prevention in these young women.…”

The Female Athlete Triad and Abnormal Pubertal Development

“…Overall, studies of COC in adolescent females with anorexia nervosa have not shown improvement in BMD [ 86 , 87 ] although a meta-analysis did indicate that COC may attenuate bone loss at the lumbar spine [ 88 ]. However due to masking of spontaneous menstrual return, a marker for suffi cient energy availability and weight adequacy, as well as lack of extensive evidence for their use, the authors recommended against the use of COCs in these females with anorexia nervosa [ 88 ]. Studies in adolescent athletes who are amenorrheic also do not support the use of COC to improve BMD [ 25 , 89 ].…”

Anorexia nervosa: diagnosis, risk factors and evidence‐based treatments

“…Osteoporosis is not only a problem of females but also of male patients, owing to their deficits in gonadal hormones. 102,103 Treatment of bone mineral density (BMD) • Although calcium and vitamin D supplementation increase BMD in the short term in healthy adolescents, no RCTs have been done in AN 104,105 • Oral oestrogen/progestin has not been found to effectively increase BMD in AN [106][107][108] • One study found that physiological doses of transdermal oestrogen increased spine and hip BMD compared with controls 109 • Although bisphosphonates have been found to increase BMD in adolescents and young adults with AN, the effect is modest and their use is not recommended 110,111 Given the increased fracture risk, dual-energy X-ray absorptiometry scans should be obtained when amenorrhea is present for six months or more 112,113 Cardiovascular system Patients with eating disorders often present with bradycardia, hypotension, arrhythmias and changes in heart rate variability Hypotension and postural changes in heart rate and blood pressure can result from decreased cardiac mass leading to systolic dysfunction, in addition to volume depletion and autonomic dysfunction 117,119,120 Endocrine Girls and boys may present with decelerated linear growth, pubertal delay or pubertal regression, and menstrual dysfunction is common in females. Progesterone level is monotonously low and corresponds to the basal level of first phase of menstrual cycle.…”