Endocrine Abstracts

The physiological adaptations associated with energy deficiency contribute to menstrual cycle disturbances. The downstream effects of both energy deficiency and hypoestrogenism synergistically impair bone health, leading to low bone mineral density, compromised bone structure and microarchitecture, and ultimately, a decrease in bone strength. Low bone mineral density is frequently observed among exercising women and anorexic women with functional hypothalamic amenorrhea (FHA) secondary to an energy deficiency. In these women with chronic energy deficiency, chronic hypoestrogenism also plays a significant role in the bone loss observed. Both amenorrheic athletes and anorexic women present with low BMD, decreased trabecular volumetric low bone mass and a deterioration of trabecular microarchitecture, indicating that the synergistic effects of an energy deficiency and estrogen deficiency impair bone quantity and quality, especially within trabecular regions. In the absences of a therapeutic intervention, 2–3% of bone loss per year is observed in these women. Therapeutic strategies to reverse bone loss in athletes and anorexic women with FHA and energy deficiency have included non-pharmacological approaches that target body weight restoration and resumption of menses. Several pharmacological strategies that include, combined oral contraceptives, transdermal estrogen, recombinant leptin and IGF1, and bisphosphonates have also been evaluated. The risks and benefits of non-pharmacological and pharmacological therapies to reverse bone loss in these energy deficient populations will be discussed. To date, the reversal of menses and restoration of body weight has resulted in the most promising improvements in bone health in both amenorrheic athletes and anorexic women.