Table 1.

Hormonal alterations in anorexia nervosa and their potential effect on bone mass

Hormonal abnormalities	Associations with bone mineral density (BMD)	Effects of treating hormonal alteration (duration of treatment)	References
Hypogonadotropic hypogonadism	Duration of amenorrhea is associated with decreased BMD in anorexia nervosa	Oral estrogen (mean of 1–1.5 yrs): No difference in BMD compared to placebo except in very low weight women Physiologic transdermal estrogen (1.5 yrs): 2.6% increase in spine BMD in adolescent girls	[22-24] [25]
Low IGF-I levels due to growth hormone resistance	Low IGF-I levels are associated with decreased BMD in anorexia nervosa	rhIGF-I + oral contraceptives (9 months): 1.8% increase in spine BMD	[24, 51]
Low testosterone levels	Low testosterone levels are associated with low BMD in anorexia nervosa	Transdermal testosterone (1 yr): No difference in BMD compared to placebo	[29]
Low DHEA levels	Low DHEA levels are associated with low BMD in anorexia nervosa	DHEA (1 yr): No change compared to placebo DHEA + OCPs (1.5 yrs): Results in maintenance of BMD as compared to loss of BMD in placebo group	[71] [72]
Hypercortisolemia	High cortisol levels are associated with decreased BMD in anorexia nervosa	No treatments investigated	[22, 75]
Low leptin levels	Low leptin levels are associated with decreased BMD in anorexia nervosa and worsened microarchitectural parameters	Not investigated in AN In hypothalamic amenorrhea, treatment with rhleptin results in increases in markers of bone formation but also weight loss and therefore this is not a potential treatment for individuals with anorexia nervosa	[33, 34]
Elevated PYY levels	Elevated PYY levels are associated with decreased BMD in girls and women with anorexia nervosa	No treatments investigated	[66, 94]
Low oxytocin levels	Low oxytocin levels are associated with low BMD in anorexia nervosa	No treatments investigated	[106]