Lauren Robinson1, Victoria Aldridge2, Emma M Clark3, Madhusmita Misra4, Nadia Micali5. 1. Institute of Child Health, University College London, Gower Street, London WC1E 6BT, UK; Dept. of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA. Electronic address: Lauren.robinson.14@ucl.ac.uk. 2. Institute of Child Health, University College London, Gower Street, London WC1E 6BT, UK. 3. Musculoskeletal Research Unit, University of Bristol, Bristol, UK. 4. Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA. 5. Institute of Child Health, University College London, Gower Street, London WC1E 6BT, UK; Dept. of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA.
Abstract
OBJECTIVE: Although there are several evidence-based treatments available to increase Bone Mineral Density (BMD) and reduce fracture risk in aging men and women, there are still uncertainties regarding which treatments are efficacious in reducing lifetime fracture risk in women with Anorexia Nervosa (AN). METHODS: Medline, PsychInfo, Embase and the Cochrane Database were searched for English Language Studies. Inclusion criteria were studies of females of any age with AN who received pharmacological treatment with the primary aim to increase BMD or reduce fracture risk. Data were extracted from each study regarding pharmacological treatment and dosage used, BMD and bone formation marker outcomes; and participant characteristics including age, Body Mass Index (BMI), duration of AN, and duration of amenorrhea. RESULTS: 675 studies were reviewed, of which 19 fit the inclusion criteria and were included in the final review, investigating a total of 1119 participants; 10 of the 19 included studies were double-blind RCTs. The remaining studies consisted of prospective observational studies, a retrospective cohort study, a case-control study and five non-randomised control trials. Bisphosphonates were effective in increasing BMD in adult women with AN, while estrogen administered transdermally resulted in significant increases in BMD in mature adolescents with AN. Administration of oral contraceptives (OC) did not significantly increase BMD in randomised or controlled trials, however, lifetime OC use was associated with higher spinal BMD. CONCLUSION: Future research should clarify the safety of long-term bisphosphonate use in adult women with AN, and verify that transdermal estrogen replacement increases BMD in women with AN.
OBJECTIVE: Although there are several evidence-based treatments available to increase Bone Mineral Density (BMD) and reduce fracture risk in aging men and women, there are still uncertainties regarding which treatments are efficacious in reducing lifetime fracture risk in women with Anorexia Nervosa (AN). METHODS: Medline, PsychInfo, Embase and the Cochrane Database were searched for English Language Studies. Inclusion criteria were studies of females of any age with AN who received pharmacological treatment with the primary aim to increase BMD or reduce fracture risk. Data were extracted from each study regarding pharmacological treatment and dosage used, BMD and bone formation marker outcomes; and participant characteristics including age, Body Mass Index (BMI), duration of AN, and duration of amenorrhea. RESULTS: 675 studies were reviewed, of which 19 fit the inclusion criteria and were included in the final review, investigating a total of 1119 participants; 10 of the 19 included studies were double-blind RCTs. The remaining studies consisted of prospective observational studies, a retrospective cohort study, a case-control study and five non-randomised control trials. Bisphosphonates were effective in increasing BMD in adult women with AN, while estrogen administered transdermally resulted in significant increases in BMD in mature adolescents with AN. Administration of oral contraceptives (OC) did not significantly increase BMD in randomised or controlled trials, however, lifetime OC use was associated with higher spinal BMD. CONCLUSION: Future research should clarify the safety of long-term bisphosphonate use in adult women with AN, and verify that transdermal estrogen replacement increases BMD in women with AN.
Authors: Neville H Golden; Elba A Iglesias; Marc S Jacobson; Dennis Carey; Wendy Meyer; Janet Schebendach; Stanley Hertz; I Ronald Shenker Journal: J Clin Endocrinol Metab Date: 2005-03-22 Impact factor: 5.958
Authors: B Ettinger; D M Black; B H Mitlak; R K Knickerbocker; T Nickelsen; H K Genant; C Christiansen; P D Delmas; J R Zanchetta; J Stakkestad; C C Glüer; K Krueger; F J Cohen; S Eckert; K E Ensrud; L V Avioli; P Lips; S R Cummings Journal: JAMA Date: 1999-08-18 Impact factor: 56.272
Authors: Gabriella Milos; Hans-Jörg Häuselmann; Marc-Antoine Krieg; Peter Rüegsegger; Luigi M Gallo Journal: Bone Date: 2013-09-29 Impact factor: 4.398
Authors: Madhusmita Misra; Rajani Prabhakaran; Karen K Miller; Mark A Goldstein; Diane Mickley; Laura Clauss; Patrice Lockhart; Jennalee Cord; David B Herzog; Debra K Katzman; Anne Klibanski Journal: J Clin Endocrinol Metab Date: 2007-12-18 Impact factor: 5.958
Authors: Lauren Robinson; Victoria K Aldridge; Emma M Clark; Madhusmita Misra; Nadia Micali Journal: J Psychosom Res Date: 2018-12-17 Impact factor: 3.006