Effect of oral and transdermal oestrogen therapy on bone mineral density in functional hypothalamic amenorrhoea: a systematic review and meta-analysis
Background Female athletes might develop reduced bone mineral density (BMD) and amenorrhoea due to low energy intake.Objective To systematically review the literature of randomised controlled trials (RCTs) assessing the effect of oestrogen oral contraceptives (OCP), conjugated oestrogens (CE) and tr...
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BMJ Publishing Group
2021-09-01
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| Series: | BMJ Open Sport & Exercise Medicine |
| Online Access: | https://bmjopensem.bmj.com/content/7/3/e001112.full |
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| author | Knut Stavem Michael Bjørn Russell Aleksander Chaibi Karoline Aalberg Frode Norheim |
| author_facet | Knut Stavem Michael Bjørn Russell Aleksander Chaibi Karoline Aalberg Frode Norheim |
| author_sort | Knut Stavem |
| collection | DOAJ |
| description | Background Female athletes might develop reduced bone mineral density (BMD) and amenorrhoea due to low energy intake.Objective To systematically review the literature of randomised controlled trials (RCTs) assessing the effect of oestrogen oral contraceptives (OCP), conjugated oestrogens (CE) and transdermal estradiol (TE) on BMD in premenopausal women with functional hypothalamic amenorrhoea (FHA) due to weight loss, vigorous exercise and/or stress.Methods A comprehensive literature search in PubMed, MEDLINE, Cochrane Library, Ovid and CINAHL from inception to 1 October 2020.Data extraction and synthesis Two authors independently extracted data. When possible, the data were pooled in a random-effects meta-analysis.Main outcomes Difference in BMD (g/cm2) at the lumbar spine.Results Nine RCTs comprising 770 participants met the inclusion criteria; five studies applied OCP, two CE and two TE. Four RCTs (two OCP, two TE) found an increased BMD in premenopausal women with FHA, and five (three OCP, two CE) found a decreased BMD compared with controls. A meta-analysis showed no difference in BMD between the treatment and control groups, (standardised mean difference (SMD) 0.30, 95% CI −0.12 to 0.73). A secondary analysis for change scores from baseline to first assessment point, showed a similar overall result (SMD 0.17, 95% CI −0.16 to 0.51). No serious adverse events were reported.Conclusion The literature suggests that TE might increase lumbar BMD in premenopausal women with FHA, but pooled results revealed no effect of the intervention. The findings do not support oestrogen therapy to improve BMD in these patient groups. |
| format | Article |
| id | doaj-art-6f44e2e496fc401880a66ceefd1e0ab7 |
| institution | OA Journals |
| issn | 2055-7647 |
| language | English |
| publishDate | 2021-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Sport & Exercise Medicine |
| spelling | doaj-art-6f44e2e496fc401880a66ceefd1e0ab72025-08-20T02:11:34ZengBMJ Publishing GroupBMJ Open Sport & Exercise Medicine2055-76472021-09-017310.1136/bmjsem-2021-001112Effect of oral and transdermal oestrogen therapy on bone mineral density in functional hypothalamic amenorrhoea: a systematic review and meta-analysisKnut Stavem0Michael Bjørn Russell1Aleksander Chaibi2Karoline Aalberg3Frode Norheim4Institute of Clinical Medicine, University of Oslo, Lørenskog, NorwayInstitute of Clinical Medicine, Akershus University Hospital, Lorenskog, Norwaysenior researcherAtlasklinikken, Oslo, NorwayDepartment of Nutrition, University of Oslo, Institute of Basic Medical Sciences, Oslo, NorwayBackground Female athletes might develop reduced bone mineral density (BMD) and amenorrhoea due to low energy intake.Objective To systematically review the literature of randomised controlled trials (RCTs) assessing the effect of oestrogen oral contraceptives (OCP), conjugated oestrogens (CE) and transdermal estradiol (TE) on BMD in premenopausal women with functional hypothalamic amenorrhoea (FHA) due to weight loss, vigorous exercise and/or stress.Methods A comprehensive literature search in PubMed, MEDLINE, Cochrane Library, Ovid and CINAHL from inception to 1 October 2020.Data extraction and synthesis Two authors independently extracted data. When possible, the data were pooled in a random-effects meta-analysis.Main outcomes Difference in BMD (g/cm2) at the lumbar spine.Results Nine RCTs comprising 770 participants met the inclusion criteria; five studies applied OCP, two CE and two TE. Four RCTs (two OCP, two TE) found an increased BMD in premenopausal women with FHA, and five (three OCP, two CE) found a decreased BMD compared with controls. A meta-analysis showed no difference in BMD between the treatment and control groups, (standardised mean difference (SMD) 0.30, 95% CI −0.12 to 0.73). A secondary analysis for change scores from baseline to first assessment point, showed a similar overall result (SMD 0.17, 95% CI −0.16 to 0.51). No serious adverse events were reported.Conclusion The literature suggests that TE might increase lumbar BMD in premenopausal women with FHA, but pooled results revealed no effect of the intervention. The findings do not support oestrogen therapy to improve BMD in these patient groups.https://bmjopensem.bmj.com/content/7/3/e001112.full |
| spellingShingle | Knut Stavem Michael Bjørn Russell Aleksander Chaibi Karoline Aalberg Frode Norheim Effect of oral and transdermal oestrogen therapy on bone mineral density in functional hypothalamic amenorrhoea: a systematic review and meta-analysis BMJ Open Sport & Exercise Medicine |
| title | Effect of oral and transdermal oestrogen therapy on bone mineral density in functional hypothalamic amenorrhoea: a systematic review and meta-analysis |
| title_full | Effect of oral and transdermal oestrogen therapy on bone mineral density in functional hypothalamic amenorrhoea: a systematic review and meta-analysis |
| title_fullStr | Effect of oral and transdermal oestrogen therapy on bone mineral density in functional hypothalamic amenorrhoea: a systematic review and meta-analysis |
| title_full_unstemmed | Effect of oral and transdermal oestrogen therapy on bone mineral density in functional hypothalamic amenorrhoea: a systematic review and meta-analysis |
| title_short | Effect of oral and transdermal oestrogen therapy on bone mineral density in functional hypothalamic amenorrhoea: a systematic review and meta-analysis |
| title_sort | effect of oral and transdermal oestrogen therapy on bone mineral density in functional hypothalamic amenorrhoea a systematic review and meta analysis |
| url | https://bmjopensem.bmj.com/content/7/3/e001112.full |
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