October 25, 2010 (Toronto, Ontario) — A regimen that combines oral dehydroepiandrosterone (DHEA) with hormone replacement therapy (HRT) increases bone mineral density in young women with anorexia nervosa, according to new research presented here at the American Society for Bone and Mineral Research 2010 Annual Meeting.
"Many of these women struggle with poor nutrition for very long periods of time. We take care of a number of adolescents with anorexia and we've been looking for ways to prevent and treat the skeletal problems that we identify," said Amy DiVasta, MD, MMSc, from Children's Hospital Boston in Massachusetts. "Many studies to date have been fairly disappointing, so we wanted to see if we could find a better treatment."
Previous studies have shown that HRT alone does not prevent bone loss in anorexia nervosa and that DHEA, although it does increase bone density, also causes weight gain, making adherence a particular problem in this patient population, she said.
In this study, 80 women with anorexia nervosa, aged 13 to 27 years, were randomized to receive, for 18 months, either 50 mg per day of micronized DHEA plus HRT with 20 µg of ethinyl estradiol per 0.1 mg levonorgestrel, or placebo.
The investigators report that over the 18 months of the study, femoral shaft bone mineral density increased by 3.4% in the DHEA plus HRT group, and decreased by 2.1% in the placebo group (time × treatment; P < .01).
Femoral shaft cross-sectional area increased by 2.5% in the treatment group, and decreased by 1.8% in the placebo group (P <.01). There was no difference in shaft section modulus.
Shaft buckling ratio, which is a measure of fracture risk, decreased in the treatment group by 5.9%, and rose by 2.7% in the placebo group (P =.02). There was no difference in hip geometry at the femoral narrow neck between the 2 groups, Dr. DiVasta said.
"We are not sure of the mechanism but we think DHEA works by helping to stimulate bone formation in these girls. Normally, bone formation is very suppressed in patients with anorexia nervosa, much as it is in elderly patients," Dr. DiVasta told Medscape Medical News.
"We hope that clinicians will consider offering this as a short-term therapy for girls who are working to restore their nutrition," she said in an interview. "So far, we have been so limited in the options we have to help these young women. It's nice to feel like we've identified something to make a difference for them while they are going through their psychological recovery."
The moderators of the session agreed.
"These are interesting data that should add to clinical practice," Adi Cohen, MD, MHS, from Columbia University Medical Center in New York City, said during an interview with Medscape Medical News. "Especially in a population that is so difficult to treat, the results are encouraging."
Madhusmita Misra, MD, MPH, from Massachusetts General Hospital in Boston, emphasized that stressing weight recovery is crucial in women with anorexia nervosa. "This is a group that has very limited treatment options. I hope we can learn more about the best ways to improve nutritional rehabilitation, because that is the primary goal. We also need to address issues of compliance with the study medications. We didn't have time to talk about that here today, but that is often an issue, particularly long-term," she said.
"It was a good study," Dr. Misra, who was not part of the study, added.
Dr. DiVasta, Dr. Cohen, and Dr. Misra have disclosed no relevant financial relationships.
American Society for Bone and Mineral Research (ASBMR) 2010 Annual Meeting: Abstract 1212. Presented October 18, 2010.
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Cite this: DHEA Plus Hormone Therapy Increases Bone Mass in Girls With Anorexia Nervosa - Medscape - Oct 25, 2010.