The effect of gonadal and adrenal steroid therapy on skeletal health in adolescents and young women with anorexia nervosa

• Published in: Metabolism, clinical and experimental clinical and experimental, 2012-07, Vol.61 (7), p.1010-1020
• Main Authors: DiVasta, Amy D, Feldman, Henry A, Giancaterino, Courtney, Rosen, Clifford J, LeBoff, Meryl S, Gordon, Catherine M
• Format: Article
• Language: English
• Subjects: Adolescence; Adolescent; Adult; Adult and adolescent clinical studies; Anorexia nervosa; Anorexia Nervosa - drug therapy; Biological and medical sciences; Body composition; Body Composition - drug effects; Bone; Bone and Bones - drug effects; Bone and Bones - metabolism; Bone Density - drug effects; Bone loss; Bone mass; Bone mineral density; Bone turnover; Contraceptives (oral); Contraceptives, Oral, Combined - blood; Contraceptives, Oral, Combined - therapeutic use; Dehydroepiandrosterone; Dehydroepiandrosterone - blood; Dehydroepiandrosterone - therapeutic use; Double-Blind Method; Drug Therapy, Combination; Drugs; Eating behavior disorders; Eating disorders; Endocrinology & Metabolism; Estrogens; Estrogens - blood; Estrogens - therapeutic use; Ethinyl estradiol; Ethinyl Estradiol - blood; Ethinyl Estradiol - therapeutic use; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Hormones; Humans; Levonorgestrel - blood; Levonorgestrel - therapeutic use; Medical sciences; progestin; Progestins - blood; Progestins - therapeutic use; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Sex hormones; Side effects; Skeleton; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Young Adult
• ISSN: 0026-0495; 1532-8600
• DOI: 10.1016/j.metabol.2011.11.016

Abstract Anorexia nervosa (AN) is characterized by subnormal estrogen and dehydroepiandrosterone (DHEA) levels. We sought to determine whether the combination of DHEA + estrogen/progestin is superior to placebo in preserving skeletal health over 18 months in AN. Females with AN, aged 13 to 27 years, were recruited for participation in this double-blind, placebo-controlled, randomized trial. Ninety-four subjects were randomized, of whom 80 completed baseline assessments and received either study drug (oral micronized DHEA 50 mg + 20 µ g ethinyl estradiol/0.1 mg levonorgestrel combined oral contraceptive pill [COC] daily; n = 43) or placebo (n = 37). Serial measurements of areal bone mineral density (aBMD), bone turnover markers, and serum hormone concentrations were obtained. Sixty subjects completed the 18-month trial. Spinal and whole-body aBMD z scores were preserved in the DHEA + COC group, but decreased in the placebo group (comparing trends, P = .008 and P = .001, respectively). Bone turnover markers initially declined in subjects receiving DHEA + COC and then returned to baseline. No differences in body composition, adverse effects of therapy, or alterations in biochemical safety parameters were observed. Combined therapy with DHEA + COC appears to be safe and effective for preventing bone loss in young women with AN, whereas placebo led to decreases in aBMD. Dehydroepiandrosterone + COC may be safely used to preserve bone mass as efforts to reverse the nutritional, psychological, and other hormonal components of AN are implemented.