The Effect of Estrogen-Progestin Treatment on Bone Mineral Density in Anorexia Nervosa

Medical complications in adolescents with anorexia nervosa: A review of the literature

“…50 To date, there is no evidence that hormone replacement therapy (HRT) effectively reverses or prevents bone loss in adolescents with AN. A 1-year 51 prospective observational study in adolescents with AN who received either estrogen-progestin or no hormonal treatment had no significant differences in absolute values or in the net change of lumbar-spine or femoral-neck BMD between the two groups at follow-up. In addition, Munoz et al 52 also studied the effect of oral estrogen/progestin administration on bone loss in young women with AN.…”

Optimizing Bone Health in Children and Adolescents

“…Mechanical loading during weight-bearing activities stimulates bone formation, and multiple studies in healthy adolescents 8,[71][72][73] and in those with anorexia nervosa [74][75][76][77] have demonstrated that BMD is directly correlated with BMI. Lean body mass is most strongly associated with BMD, 78 but increased adiposity can also be associated with increased fracture risk.…”

“…84 Eating disorders are prevalent in adolescents. 85 Anorexia nervosa is associated with reduced BMD and increased fracture risk, [74][75][76][86][87][88][89] and the reduction in bone mass occurs after a relatively short duration of illness. 74,90 Etiologic factors include poor nutrition, low body weight, estrogen deficiency, and hypercortisolism.…”

“…131 Prospective cohort studies and randomized controlled trials have both shown that oral contraceptives do not increase bone mass in subjects with anorexia nervosa or in female athletes. 75,[132][133][134][135] Because of this lack of demonstrated efficacy, their use is not recommended to increase bone mass. In girls with anorexia nervosa, oral contraceptives will induce monthly menstruation, which may be incorrectly interpreted as an indication of adequate weight restoration.…”

Eating disorders in adolescentsposition paper of the Society for Adolescent Medicine

“…Most of the medical complications in adolescents with an eating disorder improve with nutritional rehabilitation and recovery from the eating disorder, but some are potentially irreversible. Potentially irreversible medical complications in adolescents include: growth retardation if the disorder occurs before closure of the epiphyses [10,11,[23][24][25][26]; loss of dental enamel with chronic vomiting [27]; structural brain changes noted on cerebral tomography, magnetic resonance imaging and single-photon computerized tomography studies [28,29]; pubertal delay or arrest [30,31]; and impaired acquisition of peak bone mass [9,13,[32][33][34][35], predisposing to osteoporosis and increased fracture risk. These features underscore the importance of immediate medical management, ongoing monitoring and aggressive treatment by physicians who understand adolescent growth and development.…”