Transdermal Estrogen in Women With Anorexia Nervosa: An Exploratory Pilot Study
Transdermal Estrogen in Women With Anorexia Nervosa: An Exploratory Pilot Study
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DOI：
10.1002/jbm4.10251
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发表时间：
2020-01-01
期刊：
影响因子：
3.8
通讯作者：
Fazeli, Pouneh K.
中科院分区：
文献类型：
--
作者：
Resulaj, Megi;Polineni, Sai;Fazeli, Pouneh K.
神经性厌食症 (AN) 是一种精神疾病，其特征是自我饥饿、低体重和骨髓脂肪组织 (BMAT) 水平升高。 BMAT 与 AN 中的 BMD 呈负相关，超过 85% 的 AN 女性骨量较低且骨折风险增加。尽管大多数患有 AN 的女性患有闭经，这与骨密度较低有关，但含有超生理剂量雌激素的口服避孕药并不能有效增加骨量。我们对 11 名 AN 女性（平均年龄 +/- SEM：37.2 +/- 2.3 岁）进行了一项为期 6 个月的开放性研究，采用透皮雌二醇（0.045 毫克/天）+ 左炔诺孕酮（0.015 毫克/天），以研究透皮、生理剂量的雌激素对 AN 女性 BMD 和 BMAT 的影响。我们通过 DXA 测量了 BMD 的变化，通过 H-1 磁共振波谱测量了脊柱/髋部 BMAT 的变化，并在透皮雌激素 3 和 6 个月后测量了 C 末端胶原交联 (CTX)、P1NP、骨钙素、IGF-1 和硬化素的变化。经皮雌激素治疗 6 个月后，腰椎 (2.0% +/- 0.8%；p = 0.033) 和侧脊柱 (3.2% +/- 1.1%；p = 0.015) BMD 增加。 3 个月后腰椎 BMAT 显着下降（-13.9 +/- 6.0%；p = 0.046）。侧脊柱 BMD 的增加与 CTX 的减少相关（p = 0.047）。总之，短期经皮生理雌激素治疗可增加 AN 女性脊柱 BMD。需要未来的研究来评估这种治疗的长期疗效。 (C) 2019 年作者。 JBMR Plus 由 Wiley periodicals, Inc. 代表美国骨与矿物质研究学会出版。
Anorexia nervosa (AN) is a psychiatric disorder characterized by self-induced starvation, low body weight, and elevated levels of bone marrow adipose tissue (BMAT). BMAT is negatively associated with BMD in AN and more than 85% of women with AN have low bone mass and an increased risk of fracture. Although a majority of women with AN are amenorrheic, which is associated with low BMD, oral contraceptive pills, containing supraphysiologic doses of estrogen, are not effective in increasing bone mass. We performed a 6-month, open-label study of transdermal estradiol (0.045 mg/day) + levonorgestrel (0.015 mg/day) in 11 women with AN (mean age +/- SEM: 37.2 +/- 2.3 years) to investigate the effects of transdermal, physiologic doses of estrogen on BMD and BMAT in women with AN. We measured change in BMD by DXA, change in BMAT at the spine/hip by H-1-magnetic resonance spectroscopy, and change in C-terminal collagen cross-links (CTX), P1NP, osteocalcin, IGF-1, and sclerostin after 3 and 6 months of transdermal estrogen. Lumbar spine (2.0% +/- 0.8%; p = 0.033) and lateral spine (3.2% +/- 1.1%; p = 0.015) BMD increased after 6 months of transdermal estrogen. Lumbar spine BMAT decreased significantly after 3 months (-13.9 +/- 6.0%; p = 0.046). Increases in lateral spine BMD were associated with decreases in CTX (p = 0.047). In conclusion, short-term treatment with transdermal, physiologic estrogen increases spine BMD in women with AN. Future studies are needed to assess the long-term efficacy of this treatment. (C) 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.