Effect of oral contraceptives and hormone replacement therapy on bone mineral density in premenopausal and perimenopausal women: a systematic review

Liu, Selina L.; Lebrun, Constance M.

doi:10.1136/bjsm.2005.020065

Cited by 120 publications

(76 citation statements)

References 103 publications

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“…87 Moreover, Liu and Lebrun reviewed studies on the efficacy of estrogen therapy in hypothalamic amenorrhea and concluded that there is limited evidence to support a positive effect of such intervention on BMD. 88 Oral contraceptives will probably maintain bone density in hypoestrogenic, amenorrheic athletes while additionally providing contraception. Furthermore, recent studies demonstrated that the estrogen component in OC exerts a protective role on endothelial function, reducing the cardiovascular risk in amenorrheic athletes.…”

Section: Therapeutic Interventionsmentioning

confidence: 99%

Menstrual function in sports

Roupas¹,

Georgopoulos²

2011

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ObjecTIVe: To highlight the recent developments in the field of menstrual function in sports and to provide an overview of our current understanding in regard to the pathophysiology, evaluation and management strategies of exercise-related reproductive dysfunction. DeSIgn: A PUbMeD search was carried out and all articles published from 1980 to 2010 with title words related to exercise, athletes, menstrual function and primary and secondary amenorrhea were reviewed. The review structure includes a pathophysiology overview, menstrual dysfunction among different athletic disciplines, clinical manifestations, evaluation and management strategies, with particular emphasis on recent data regarding the use of oral contraceptives and hormone replacement therapy. ReSUlTS AnD cOnclUSIOn: exercise-related reproductive dysfunction appears to be multifactorial in origin and remains a diagnosis of exclusion. Recent findings underscore the endocrine role of adipose tissue in the regulation of metabolism and reproduction, providing further data on our understanding of the pathophysiology of exerciserelated reproductive dysfunction. clinical manifestations range from primary amenorrhea or delayed menarche to luteal phase deficiency, oligomenorrhea, anovulation and secondary amenorrhea. Amenorrhea constitutes the most serious clinical consequence and is associated with bone pathology. early diagnosis, thorough evaluation and individualized management (ranging from diet and exercise, or behavior adjustments to pharmacologic treatment) should be achieved in order to preserve bone mass.

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Section: Therapeutic Interventionsmentioning

confidence: 99%

Menstrual function in sports

Roupas¹,

Georgopoulos²

2011

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“…59,60 Eighty percent of population variability in bone mass is genetically determined, and 20% is explained by environmental factors (nutritional, hormonal, lifestyle and fetal influences). 57,[61][62][63][64][65] Osteoporosis is defined as BMD by T score more than 2.5 SDs below the mean BMD for young adults, and osteopenia as a BMD 1.0-2.5 below the mean BMD for young adults. 66 The terms 'osteopenia' and 'osteoporosis', as defined by BMD, can only be applied to postmenopausal women (as per WHO guidelines).…”

Section: Bone Health In An Backgroundmentioning

confidence: 99%

Current concepts in bone and reproductive health in adolescents with anorexia nervosa

Jayasinghe

Grover

Zacharin

2008

BJOG

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Anorexia nervosa (AN) initiates an adaptive response at the level of the hypothalamus, which results in a complex interplay involving most elements of the neuroendocrine axis. Consequences of onset of disease in adolescence include amenorrhoea, pubertal arrest with potential loss of target height, and osteoporosis with reduced capacity for future attainment of peak bone mass. With recovery, delay in restoration of menses is common. Hormonal therapies for restoration of bone mineral density (BMD) in adolescents have shown limited efficacy. This review will discuss the reproductive endocrine effects of AN in adolescence, and discuss new investigative tools for monitoring restoration of reproductive function and BMD in this population.Keywords Adolescence, amenorrhoea, anorexia nervosa, bone mineral density, eating disorders. IntroductionNinety percent of eating disorders present before the age of 25 years, and in the early stages they may present with menstrual dysfunction. 1 Therefore, it is important that gynaecologists have a good understanding of current concepts of hypothalamic regulation, as those physicians may be the first point of contact in subsyndromal eating disorders. Leptin, a hormone produced by adipocytes, appears to be the critical link between energy homeostasis and neuroendocrine regulation. 2 Since its discovery in 1994, 3 rapid gains in understanding of the hormonal and nutritional regulation of anorexia nervosa (AN) have occurred. 4 These findings are likely to have a significant impact on clinical management of the reproductive-endocrine aspects of AN. Bone loss consequent upon estrogen deficiency may be severe, of long duration with reduced capacity for recovery. Understanding bone loss mechanisms, correct interpretation of bone density measurements and consideration of treatment modalities to ameliorate the problems of eating disorders are an essential part of overall management strategies. EpidemiologyThe Society for Adolescent Medicine together with other medical bodies has recognised that strict Diagnostical and Statistical Manual of Mental Health Disorders-IV (DSM-IV) criteria 5 for AN (particularly requiring weight below 85% of normal and amenorrhoea for 3 months), may not apply to all women. 6,7 This is particularly so in adolescents because of their normal variability in development, and also because adverse health effects occur even in partial syndromes. In adolescence, prevalence of AN is 0.5%, bulimia nervosa is 1% and partial syndromes (eating disorders not otherwise specified) is 2.4-5.0%. 6,[8][9][10] Clinical sequelaeThe clinical sequelae of AN depend on timing of disease in relation to puberty. These may include pubertal delay and primary amenorrhoea, pubertal arrest with potential loss of target height, or secondary amenorrhoea. 11-13 Amenorrhoea has been reported to precede weight loss in 20% of women, which may lead to diagnostic confusion.Low bone mineral density (BMD) is an established risk in AN, with 50% of anorexics demonstrating osteopenia within 20 months of ameno...

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“…This strain causes deformation of bone. The mechanostat theory proposes that bone is capable of sensing biomechanical strain through an internal "mechanostat", thereby adjusting the level of remodelling accordingly to increase bone accretion (Snow, 1996;Barr & McKay, 1998;Voss, Fadale & Hulstyn, 1998;Kemmler et al, 2006;Liu & Lebrun, 2006). BMD accrual usually protects against osteoporosis and subsequent fractures later on in life, especially in females.…”

Section: Introductionmentioning

confidence: 99%

The effect of a 12-week exercise programme on bone mineral density in young South African females

Egbunike¹,

Wood²,

Grant³

2010

Af. J. Phys, Health Edu. Rec. & Dance

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A longer lifespan has increased the emphasis on bone health, which is often compromised with age. Studies have shown that exercise yields a positive influence on bone mineral density (BMD), especially when done during the early years of life (second to third decades). A 12-week study was undertaken using dual-energy X-ray absorptiometry (DEXA) to assess changes in BMD (total, lumbar and neck of the femur) in 70 females (mean age 20.1 years) before and after a 12-week intense exercise programme. The exercise programme consisted of a daily 5 km run and two isolated resistance exercises for each body region. The Wilcoxon signed-rank test was used to determine if any changes took place after the intervention. Statistically significant increases occurred in only the BMD of the lumbar spine (L1-L4) (2.54%) and neck of the femur (NOF) (9.35%), with clinical significance shown only in the NOF, as the increase was greater than 7%. This study's results thus indicate that a relatively short intense intervention of 12 weeks can improve BMD in young women, thereby possibly assisting in preventing osteoporosis and fractures later on in life. Further studies are recommended to determine the minimum time needed to achieve a clinically significant change in the total BMD as well as the lumbar spine BMD.

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Effect of oral contraceptives and hormone replacement therapy on bone mineral density in premenopausal and perimenopausal women: a systematic review

Cited by 120 publications

References 103 publications

Menstrual function in sports

Menstrual function in sports

Current concepts in bone and reproductive health in adolescents with anorexia nervosa

The effect of a 12-week exercise programme on bone mineral density in young South African females

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