Bone health in functional hypothalamic amenorrhea: What the endocrinologist needs to know
In the original definition by Klinefelter, Albright and Griswold, the expression “hypothalamic hypoestrogenism” was used to describe functional hypothalamic amenorrhoea (FHA). Given the well-known effects of estrogens on bone, the physiopathology of skeletal fragility in this condition may appear se...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-10-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2022.946695/full |
| _version_ | 1811194577924653056 |
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| author | Rita Indirli Rita Indirli Valeria Lanzi Valeria Lanzi Giovanna Mantovani Giovanna Mantovani Maura Arosio Maura Arosio Emanuele Ferrante |
| author_facet | Rita Indirli Rita Indirli Valeria Lanzi Valeria Lanzi Giovanna Mantovani Giovanna Mantovani Maura Arosio Maura Arosio Emanuele Ferrante |
| author_sort | Rita Indirli |
| collection | DOAJ |
| description | In the original definition by Klinefelter, Albright and Griswold, the expression “hypothalamic hypoestrogenism” was used to describe functional hypothalamic amenorrhoea (FHA). Given the well-known effects of estrogens on bone, the physiopathology of skeletal fragility in this condition may appear self-explanatory. Actually, a growing body of evidence has clarified that estrogens are only part of the story. FHA occurs in eating disorders, overtraining, and during psychological or physical stress. Despite some specific characteristics which differentiate these conditions, relative energy deficiency is a common trigger that initiates the metabolic and endocrine derangements contributing to bone loss. Conversely, data on the impact of amenorrhoea on bone density or microarchitecture are controversial, and reduced bone mass is observed even in patients with preserved menstrual cycle. Consistently, oral estrogen-progestin combinations have not proven beneficial on bone density of amenorrheic women. Low bone density is a highly prevalent finding in these patients and entails an increased risk of stress or fragility fractures, and failure to achieve peak bone mass and target height in young girls. Pharmacological treatments have been studied, including androgens, insulin-like growth factor-1, bisphosphonates, denosumab, teriparatide, leptin, but none of them is currently approved for use in FHA. A timely screening for bone complications and a multidisciplinary, customized approach aiming to restore energy balance, ensure adequate protein, calcium and vitamin D intake, and reverse the detrimental metabolic-endocrine changes typical of this condition, should be the preferred approach until further studies are available. |
| first_indexed | 2024-04-12T00:29:33Z |
| format | Article |
| id | doaj.art-116c8055217f4e0f8a6ee6e94d45ebc2 |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-04-12T00:29:33Z |
| publishDate | 2022-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-116c8055217f4e0f8a6ee6e94d45ebc22022-12-22T03:55:24ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922022-10-011310.3389/fendo.2022.946695946695Bone health in functional hypothalamic amenorrhea: What the endocrinologist needs to knowRita Indirli0Rita Indirli1Valeria Lanzi2Valeria Lanzi3Giovanna Mantovani4Giovanna Mantovani5Maura Arosio6Maura Arosio7Emanuele Ferrante8Department of Clinical Sciences and Community Health, University of Milan, Milan, ItalyEndocrinology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Clinical Sciences and Community Health, University of Milan, Milan, ItalyEndocrinology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Clinical Sciences and Community Health, University of Milan, Milan, ItalyEndocrinology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Clinical Sciences and Community Health, University of Milan, Milan, ItalyEndocrinology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyEndocrinology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, ItalyIn the original definition by Klinefelter, Albright and Griswold, the expression “hypothalamic hypoestrogenism” was used to describe functional hypothalamic amenorrhoea (FHA). Given the well-known effects of estrogens on bone, the physiopathology of skeletal fragility in this condition may appear self-explanatory. Actually, a growing body of evidence has clarified that estrogens are only part of the story. FHA occurs in eating disorders, overtraining, and during psychological or physical stress. Despite some specific characteristics which differentiate these conditions, relative energy deficiency is a common trigger that initiates the metabolic and endocrine derangements contributing to bone loss. Conversely, data on the impact of amenorrhoea on bone density or microarchitecture are controversial, and reduced bone mass is observed even in patients with preserved menstrual cycle. Consistently, oral estrogen-progestin combinations have not proven beneficial on bone density of amenorrheic women. Low bone density is a highly prevalent finding in these patients and entails an increased risk of stress or fragility fractures, and failure to achieve peak bone mass and target height in young girls. Pharmacological treatments have been studied, including androgens, insulin-like growth factor-1, bisphosphonates, denosumab, teriparatide, leptin, but none of them is currently approved for use in FHA. A timely screening for bone complications and a multidisciplinary, customized approach aiming to restore energy balance, ensure adequate protein, calcium and vitamin D intake, and reverse the detrimental metabolic-endocrine changes typical of this condition, should be the preferred approach until further studies are available.https://www.frontiersin.org/articles/10.3389/fendo.2022.946695/fullfunctional hypothalamic amenorrhea (FHA)female athlete triadboneosteoporosisoral contraceptives (OCs)estrogen |
| spellingShingle | Rita Indirli Rita Indirli Valeria Lanzi Valeria Lanzi Giovanna Mantovani Giovanna Mantovani Maura Arosio Maura Arosio Emanuele Ferrante Bone health in functional hypothalamic amenorrhea: What the endocrinologist needs to know Frontiers in Endocrinology functional hypothalamic amenorrhea (FHA) female athlete triad bone osteoporosis oral contraceptives (OCs) estrogen |
| title | Bone health in functional hypothalamic amenorrhea: What the endocrinologist needs to know |
| title_full | Bone health in functional hypothalamic amenorrhea: What the endocrinologist needs to know |
| title_fullStr | Bone health in functional hypothalamic amenorrhea: What the endocrinologist needs to know |
| title_full_unstemmed | Bone health in functional hypothalamic amenorrhea: What the endocrinologist needs to know |
| title_short | Bone health in functional hypothalamic amenorrhea: What the endocrinologist needs to know |
| title_sort | bone health in functional hypothalamic amenorrhea what the endocrinologist needs to know |
| topic | functional hypothalamic amenorrhea (FHA) female athlete triad bone osteoporosis oral contraceptives (OCs) estrogen |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2022.946695/full |
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