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. 2022 Jun 21;14(13):2557.
doi: 10.3390/nu14132557.

Physiologic Transdermal Estradiol Replacement Mimics Effects of Endogenous Estrogen on Bone Outcomes in Hypoestrogenic Women with Anorexia Nervosa

Vibha Singhal  1   2   3 , Supritha Nimmala  1 , Meghan Slattery  1 , Kamryn T Eddy  1   4 , Karen K Miller  1 , Anne Klibanski  1 , Madhusmita Misra  1   2
Affiliations

Physiologic Transdermal Estradiol Replacement Mimics Effects of Endogenous Estrogen on Bone Outcomes in Hypoestrogenic Women with Anorexia Nervosa

Vibha Singhal et al. Nutrients. .

Abstract

Background: While physiologic estrogen replacement results in increases in areal bone mineral density (aBMD) in hypoestrogenic adolescent girls and young adult women with AN, data are lacking regarding its impact on measures of volumetric BMD (vBMD), bone geometry, and structure. Methods: 23 young women with anorexia nervosa (AN) and 27 normal-weight healthy controls (HC) between 14−25 years old were followed for 12 months. AN participants received transdermal 17β-estradiol (continuously) with 10 days of cyclic oral progesterone (100 mg daily) every month for the study duration (AN-E+). DXA was used to measure aBMD and body composition, high resolution peripheral quantitative CT (HRpQCT) to assess vBMD, bone geometry and structure at the distal radius and tibia, and microfinite element analysis to estimate strength. Results: Groups did not differ for age. Median baseline BMI z-scores were −1.13 (−1.58, −0.38) in AN-E+ vs. 0.08 (−0.40, 0.84) in HC (p < 0.0001). For most HRpQCT parameters and strength estimates, young women with AN receiving physiologic estrogen replacement demonstrated similar changes over 12 months as did normoestrogenic HC. Additionally, radial cortical tissue mineral density, cortical vBMD, and failure load increased (p = 0.01; p = 0.02; p = 0.004 respectively) over 12 months in AN-E+ compared to HC. Conclusions: With physiologic estrogen replacement, bone accrual improved in AN to approximate changes observed in normoestrogenic controls followed without any intervention, with additional benefits observed for cortical tissue mineral density, cortical vBMD, and failure load at the radius in AN vs. controls. Thus, this strategy for estrogen replacement effectively mimics the effects of endogenous estrogen on bone structure and estimated strength.

Keywords: adolescents; anorexia nervosa; bone density; bone structure; estradiol.

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Conflict of interest statement

M.M. has served as a consultant for Abbvie and Sanofi and on the Scientific Advisory Board of Abbvie and Ipsen. All other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Percent change in DXA measures of areal BMD (bone mineral density) in the AN-E+ and healthy control groups over 12-months, * p < 0.05 for between group comparison after adjusting for age and race, † p < 0.05 for within group change.
Figure 2
Figure 2
(a) Percent change in Radial HRpQCT parameters in the AN-E+ and healthy control groups over 12-months, * p < 0.05 for between group comparison after adjusting for age and race, a p < 0.05 for between group comparisons on log conversion for right skew of data distribution, † p < 0.05 for within group change. (b) Percent change in Tibial HRpQCT parameters in the AN-E+ and healthy control groups over 12-months, * p < 0.05 for between group comparison after adjusting for age and race, † p < 0.05 for within group change. TMD: Tissue mineral density. a indicates p < 0.05 for between group comparisons on log conversion for right skew of data distribution.
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References

    1. Jagielska G., Wolanczyk T., Komender J., Tomaszewicz-Libudzic C., Przedlacki J., Ostrowski K. Bone mineral density in adolescent girls with anorexia nervosa—A cross-sectional study. Eur. Child Adolesc. Psychiatry. 2002;11:57–62. doi: 10.1007/s007870200011. - DOI - PubMed
    1. Misra M., Aggarwal A., Miller K.K., Almazan C., Worley M., Soyka L.A., Herzog D.B., Klibanski A. Effects of anorexia nervosa on clinical, hematologic, biochemical, and bone density parameters in community-dwelling adolescent girls. Pediatrics. 2004;114:1574–1583. doi: 10.1542/peds.2004-0540. - DOI - PubMed
    1. Bachrach L.K. Acquisition of optimal bone mass in childhood and adolescence. Trends Endocrinol. Metab. 2001;12:22–28. doi: 10.1016/S1043-2760(00)00336-2. - DOI - PubMed
    1. Misra M., Prabhakaran R., Miller K.K., Goldstein M.A., Mickley D., Clauss L., Lockhart P., Cord J., Herzog D.B., Katzman D.K., et al. Weight gain and restoration of menses as predictors of bone mineral density change in adolescent girls with anorexia nervosa-1. J. Clin. Endocrinol. Metab. 2008;93:1231–1237. doi: 10.1210/jc.2007-1434. - DOI - PMC - PubMed
    1. Soyka L.A., Misra M., Frenchman A., Miller K.K., Grinspoon S., Schoenfeld D.A., Klibanski A. Abnormal Bone Mineral Accrual in Adolescent Girls with Anorexia Nervosa. J. Clin. Endocrinol. Metab. 2002;87:4177–4185. doi: 10.1210/jc.2001-011889. - DOI - PubMed

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