Bone Perspectives in Functional Hypothalamic Amenorrhoea: An Update and Future Avenues

Abstract

One of the most important and potentially long-lasting detrimental consequences of Functional Hypothalamic Amenorrhoea (FHA) is on skeletal homeostasis. Beyond oestrogen deficiency, FHA is associated with a cascade of additional neuro-endocrine and metabolic alterations, some adaptive, but which combine to disrupt skeletal homeostasis. Ultimately, this leads to a two-fold increased risk of fractures in women with FHA compared to healthy eumenorrhoeic women. Although the cornerstone of management of FHA-related bone loss remains recovery of menses via restoration of metabolic/psychological balance, there is rapidly developing evidence for hormonal manipulations (with a particular emphasis on route of administration) and other pharmacological treatments that can protect or improve skeletal homeostasis in FHA. In this mini-review, we provide an update on the pathophysiology, clinical management and future avenues in the field from a bone perspective.

Irisin and Bone in Sickness and in Health: A Narrative Review of the Literature

“…Common causes of FHA include stress, marked weight loss, very low BMI, and excessive exercise [93]. Although potentially reversible, FHA is characterized by hypogonadism that could lead to a progressive risk of developing osteopenia or osteoporosis [94]. The co-existence of low energy availability (with or without eating disorders), amenorrhea or oligomenorrhea, and a reduced BMD is known as "female athlete syndrome" [95].…”