ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: J Bone Miner Res. 2020;35(2):248–260.

In brief: This randomized open-label trial in oligoamenorrheic athletes evaluated the effects of transdermal estrogen, oral estrogen or no replacement on bone metabolism, geometry, and microarchitecture. Transdermal estrogen treatment resulted in significantly greater increases in volumetric bone mineral density and other bone parameters compared to oral estrogen.

Commentary: Estrogen replacement is not the standard of care for athletes with functional hypothalamic amenorrhea. However, oligoamenorrheic athletes are estrogen deficient, have lower bone mineral density (BMD), impaired bone microarchitecture, and higher fracture rates compared to eumenorrheic athletes, and it has also been demonstrated that transdermal estrogen can mitigate some of the negative effects on bone metabolism. However, bone microarchitecture in oligoamenorrheic athletes has not been studied. In the current study, 75 oligoamenorrheic athletes (ages 14–25 years) were randomized to receive treatment with transdermal or oral estrogen, or no treatment. Bone geometry and bone microarchitecture were assessed using high-resolution peripheral quantitative CT at the distal tibia and distal radius at baseline and 1 year.

Transdermal estrogen treatment resulted in significantly greater increases in several bone parameters, including total and trabecular volumetric BMD (vBMD), cortical area and thickness, and trabecular number with transdermal estrogen compared to oral estrogen in the tibia. However, compared to no treatment, only cortical area was improved in the transdermal group and trabecular area was even decreased. Therefore, the overall findings of this study support the current guidelines that estrogen replacement is not the standard of care for athletes with functional hypothalamic amenorrhea and should only be considered in athletes who have failed to respond to non-pharmacological therapy for at least one year or who develop significant fractures with low bone density.