Anorexia Nervosa: Questioning the Effectiveness of Estrogen Replacement

Osteopenia, or loss of bone density, is one of the most serious effects of anorexia nervosa. Estrogen replacement therapy has been one treatment option; however, after a recent study, some researchers are questioning this common practice (J Pediatr Adolesc Gynecol 2002;15:135).

In a prospective observational study of 50 teenagers with anorexia nervosa who were taking either calcium supplements or estrogen, Dr. N.H. Golden and colleagues found that estrogen-progestin therapy was no more effective for bone mineral loss than standard calcium supplements and nutritional intervention. They concluded this based on dual-energy x-ray absorptiometric measurements of bone mineral density (BMD) of the lumbar spine and left hip at baseline and one year later. When the young women were first seen, they were malnourished (79.5% of ideal body weight), hypoestrogenemic (the mean estradiol level was 24 pg/ml), and had reduced bone mass (the mean lumbar spine BMD was 2.01 SD below the young adult reference mean).

Estrogen therapy didn’t increase BMD

Twenty-two adolescents took estrogen-progestin (20-35 mcg of ethinyl estradiol) daily as an oral contraceptive and 28 had standard treatment alone. All were given calcium supplements and the same medical, psychological, and nutritional intervention.

At one-year follow-up, there were no significant differences in absolute values or net change in the lumbar spine or femoral neck BMD density between those who received estrogen-progestin and those who received standard treatment. Two and three years later, bone loss persisted and in some cases was progressive.