Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline

Catherine M. Gordon; Kathryn E. Ackerman; Sarah L. Berga; Jay R. Kaplan; George Mastorakos; Madhusmita Misra; M. Hassan Murad; Nanette F. Santoro; Michelle P. Warren


J Clin Endocrinol Metab. 2017;102(5):1413-1439. 

In This Article

Commissioned Systematic Reviews

The task force developed a priori protocols for two systematic reviews to evaluate the effect of hormonal therapy and bisphosphonates in preventing bone loss in patients with FHA. After a comprehensive search of several databases for original controlled and non-controlled studies, nine were eligible (280 patients that received different hormonal therapies, none with bisphosphonate). None of the studies reported on fractures. Random-effects meta-analysis showed a statistically significant increase in BMD of the lumbar spine in patients receiving hormonal therapy compared with patients receiving control and no significant effect on BMD of the femoral neck. The quality of this evidence was low due to the high risk of bias, imprecision (very small sample size), and indirectness (for example, BMD is a surrogate outcome).