Changes in bone turnover markers and menstrual function after short-term oral DHEA in young women with anorexia nervosa

Bone loss is a serious consequence of anorexia nervosa (AN), Subnormal leve ls of serum dehydroepiandrosterone (DHEA) are seen in patients with AN and may be causally linked to their low bone density. We hypothesized that oral DHEA would decrease markers of bone resorption (urinary N-telopeptides [NT x]), and increase markers of bone formation (serum bone-specific alkaline p hosphatase and osteocalcin [OC]), Fifteen young women (age 15-22 years) wit h AN were enrolled in a 3-month, randomized, double-blinded trial of 50, 10 0, or 200 mg of daily micronized DHEA. Blood and urinary levels of adrenal and gonadal steroids and bone turnover markers were measured. No adverse cl inical side effects of DHEA were noted, and a 50 mg daily dose restored phy siologic hormonal levels. At 3 months, NTx levels had decreased significant ly in both the 50 mg (p = 0.018) and the 200 mg (p = 0.016) subgroups. OC l evels simultaneously increased within treatment groups over time (p = 0.002 ), Eight out of 15 (53%) subjects had at least one menstrual cycle while on therapy. Short-term DHEA was well-tolerated and appears to normalize bone turnover in young women with AN. Resumption of menses in over half of subje cts suggests that DHEA therapy may also lead to estradiol levels sufficient to stimulate the endometrium in this group of patients.