Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA.
Vitam Horm. 2013;92:243-57. doi: 10.1016/B978-0-12-410473-0.00009-X.
Low bone mineral density is one of the primary risks of chronic amenorrhea, and the effects of potentially long-term menstrual disruption on bone mass are serious concerns for individuals with a past or current anorexia nervosa (AN) diagnosis. As such, estrogen therapies are frequently used to address amenorrhea associated with AN. A systematic review of the literature was conducted to examine the effectiveness of estrogen therapies on bone mineral density in women with amenorrhea. Data regarding the effectiveness of oral contraceptives were of low quality and mixed, with the majority of studies finding no benefit of these treatments on bone mineral density. Hormone replacement therapy findings were also mixed, though promising results were found in a study comparing transdermal administration of physiologic estrogen, delivered in developmentally sensitive incremental doses to placebo controls. Though this study suggests a possible role for estrogen therapies in addressing bone density loss in women with AN, in general, more studies are needed. Clinical drawbacks of using these therapies in the treatment of AN, including the loss of menses resumption as a clinical marker for weight and nutritional rehabilitation, must be considered in the decision to use estrogen therapies, particularly given the uncertain effectiveness of most of these treatments.
骨矿物质密度降低是慢性闭经的主要风险之一，既往或目前患有神经性厌食症（AN）的个体，其月经长期紊乱对骨量的影响令人严重关切。因此，经常使用雌激素疗法来治疗与 AN 相关的闭经。系统回顾文献，以检查雌激素疗法对闭经妇女骨矿物质密度的有效性。关于口服避孕药有效性的数据质量较低且混杂，大多数研究发现这些治疗方法对骨矿物质密度没有益处。激素替代疗法的结果也存在差异，尽管在一项比较经皮给予生理雌激素与安慰剂对照的研究中发现了有希望的结果，但该研究是在发展敏感的递增剂量下进行的。尽管这项研究表明雌激素疗法可能在解决 AN 患者的骨密度下降方面发挥作用，但总体而言，仍需要更多的研究。在决定使用雌激素疗法治疗 AN 时，必须考虑到这些疗法的临床缺点，包括闭经恢复作为体重和营养康复的临床标志物的丧失，特别是鉴于大多数这些治疗的效果不确定。
