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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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Autores principales: Indirli, Rita, Lanzi, Valeria, Mantovani, Giovanna, Arosio, Maura, Ferrante, Emanuele
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9592968/
https://www.ncbi.nlm.nih.gov/pubmed/36303862
http://dx.doi.org/10.3389/fendo.2022.946695
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author Indirli, Rita
Lanzi, Valeria
Mantovani, Giovanna
Arosio, Maura
Ferrante, Emanuele
author_facet Indirli, Rita
Lanzi, Valeria
Mantovani, Giovanna
Arosio, Maura
Ferrante, Emanuele
author_sort Indirli, Rita
collection PubMed
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.
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spelling pubmed-95929682022-10-26 Bone health in functional hypothalamic amenorrhea: What the endocrinologist needs to know Indirli, Rita Lanzi, Valeria Mantovani, Giovanna Arosio, Maura Ferrante, Emanuele Front Endocrinol (Lausanne) Endocrinology 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. Frontiers Media S.A. 2022-10-11 /pmc/articles/PMC9592968/ /pubmed/36303862 http://dx.doi.org/10.3389/fendo.2022.946695 Text en Copyright © 2022 Indirli, Lanzi, Mantovani, Arosio and Ferrante https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Indirli, Rita
Lanzi, Valeria
Mantovani, Giovanna
Arosio, Maura
Ferrante, Emanuele
Bone health in functional hypothalamic amenorrhea: What the endocrinologist needs to know
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 Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9592968/
https://www.ncbi.nlm.nih.gov/pubmed/36303862
http://dx.doi.org/10.3389/fendo.2022.946695
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