Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jun 20:13:923791.
doi: 10.3389/fendo.2022.923791. eCollection 2022.

Bone Perspectives in Functional Hypothalamic Amenorrhoea: An Update and Future Avenues

Preeshila Behary  1   2   3 , Alexander N Comninos  1   2   3
Affiliations
Review

Bone Perspectives in Functional Hypothalamic Amenorrhoea: An Update and Future Avenues

Preeshila Behary et al. Front Endocrinol (Lausanne). .

Abstract

One of the most important and potentially long-lasting detrimental consequences of Functional Hypothalamic Amenorrhoea (FHA) is on skeletal homeostasis. Beyond oestrogen deficiency, FHA is associated with a cascade of additional neuro-endocrine and metabolic alterations, some adaptive, but which combine to disrupt skeletal homeostasis. Ultimately, this leads to a two-fold increased risk of fractures in women with FHA compared to healthy eumenorrhoeic women. Although the cornerstone of management of FHA-related bone loss remains recovery of menses via restoration of metabolic/psychological balance, there is rapidly developing evidence for hormonal manipulations (with a particular emphasis on route of administration) and other pharmacological treatments that can protect or improve skeletal homeostasis in FHA. In this mini-review, we provide an update on the pathophysiology, clinical management and future avenues in the field from a bone perspective.

Keywords: HRT; IGF1; bone mineral density; fractures; functional hypothalamic amenorrhoea; kisspeptin; osteoporosis.

PubMed Disclaimer

Conflict of interest statement

AC has received non-promotional educational lecture honoraria and conference support from Amgen. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Pathophysiology and the effects of FHA on bone.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Pinheiro AP, Thornton LM, Plotonicov KH, Tozzi F, Klump KL, Berrettini WH, et al. . Patterns of Menstrual Disturbance in Eating Disorders. Int J Eat Disord (2007) 40(5):424–34. doi: 10.1002/eat.20388 - DOI - PubMed
    1. Keski-Rahkonen A, Mustelin L. Epidemiology of eating disorders in Europe: prevalence, incidence, comorbidity, course, consequences, and risk factors. Curr Opin Psychiatry (2016) 29(6):340–5. doi: 10.1097/YCO.0000000000000278 - DOI - PubMed
    1. Gibbs JC, Williams NI, De Souza MJ. Prevalence of Individual and Combined Components of the Female Athlete Triad. Med Sci Sports Exerc. (2013) 45(5):985–96. doi: 10.1249/MSS.0b013e31827e1bdc - DOI - PubMed
    1. Kandemir N, Slattery M, Ackerman KE, Tulsiani S, Bose A, Singhal V, et al. . Bone Parameters in Anorexia Nervosa and Athletic Amenorrhea: Comparison of Two Hypothalamic Amenorrhea States. J Clin Endocrinol Metab (2018) 103(6):2392–402. doi: 10.1210/jc.2018-00338 - DOI - PMC - PubMed
    1. Frølich J, Winkler LA, Abrahamsen B, Bilenberg N, Hermann AP, Støving RK. Fractures in Women With Eating Disorders-Incidence, Predictive Factors, and the Impact of Disease Remission: Cohort Study With Background Population Controls. Int J Eat Disord (2020) 53(7):1080–7. doi: 10.1002/eat.23223 - DOI - PubMed

Publication types