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Effect of Transdermal Estradiol and Insulin-like Growth Factor-1 on Bone Endpoints of Young Women With Anorexia Nervosa
- Source :
- J Clin Endocrinol Metab
- Publication Year :
- 2021
- Publisher :
- The Endocrine Society, 2021.
-
Abstract
- Context Anorexia nervosa (AN) is prevalent in adolescent girls and is associated with bone impairment driven by hormonal alterations in nutritional deficiency. Objective To assess the impact of estrogen replacement with and without recombinant human insulin-like growth factor-1 (rhIGF-1) administration on bone outcomes. Design Double-blind, randomized, placebo-controlled 12-month longitudinal study. Participants Seventy-five adolescent and young adult women with AN age 14 to 22 years. Thirty-three participants completed the study. Intervention Transdermal 17-beta estradiol 0.1 mg/day with (i) 30 mcg/kg/dose of rhIGF-1 administered subcutaneously twice daily (AN-IGF-1+) or (ii) placebo (AN-IGF-1−). The dose of rhIGF-1 was adjusted to maintain levels in the upper half of the normal pubertal range. Main Outcome Measures Bone turnover markers and bone density, geometry, microarchitecture, and strength estimates. Results Over 12 months, lumbar areal bone mineral density increased in AN-IGF-1− compared to AN-IGF-1+ (P = 0.004). AN-IGF-1+ demonstrated no improvement in areal BMD in the setting of variable compliance to estrogen treatment. Groups did not differ for 12-month changes in bone geometry, microarchitecture, volumetric bone mineral density (vBMD), or strength (and results did not change after controlling for weight changes over 12 months). Both groups had increases in radial cortical area and vBMD, and tibia cortical vBMD over 12 months. Levels of a bone resorption marker decreased in AN-IGF-1− (P = 0.042), while parathyroid hormone increased in AN-IGF-1+ (P = 0.019). AN-IGF-1− experienced irregular menses more frequently than did AN-IGF-1+, but incidence of all other adverse events did not differ between groups. Conclusions We found no additive benefit of rhIGF-1 administration for 12 months over transdermal estrogen replacement alone in this cohort of young women with AN.
- Subjects :
- medicine.medical_specialty
Anorexia Nervosa
Adolescent
Bone density
medicine.drug_class
Endocrinology, Diabetes and Metabolism
Clinical Biochemistry
Parathyroid hormone
030209 endocrinology & metabolism
Context (language use)
Administration, Cutaneous
Biochemistry
Bone resorption
Bone remodeling
Young Adult
03 medical and health sciences
0302 clinical medicine
Endocrinology
Transdermal estrogen
Double-Blind Method
Bone Density
Internal medicine
medicine
Humans
Longitudinal Studies
030212 general & internal medicine
Insulin-Like Growth Factor I
Clinical Research Articles
Bone mineral
Estradiol
business.industry
Estrogen Replacement Therapy
Biochemistry (medical)
Estrogens
Treatment Outcome
Estrogen
Drug Therapy, Combination
Female
Bone Remodeling
business
Biomarkers
Subjects
Details
- ISSN :
- 19457197 and 0021972X
- Volume :
- 106
- Database :
- OpenAIRE
- Journal :
- The Journal of Clinical Endocrinology & Metabolism
- Accession number :
- edsair.doi.dedup.....6ba5a803c9fdc7e8e9091aacd2e67b19