BONE-MINERAL CHANGES IN YOUNG-WOMEN WITH HYPOTHALAMIC AMENORRHEA TREATED WITH ORAL-CONTRACEPTIVES, MEDROXYPROGESTERONE, OR PLACEBO OVER 12 MONTHS

OBJECTIVES: The objectives of this study were to assess (1) whether tr eatment with oral contraceptives, in comparison with medroxyprogestero ne and placebo, improved bone mineral in women with hypothalamic ameno rrhea and (2) whether treatment with medroxyprogesterone, in compariso n with placebo, improved bone mineral in women with hypothalamic oligo menorrhea. STUDY DESIGN: The study was a randomized, controlled clinic al trial. Twenty-four white women, aged 14 to 28 years, with hypothala mic amenorrhea or oligomenorrhea were prospectively enrolled for a 12- month intervention period. Amenorrheic subjects were randomized to rec eive oral contraceptives, medroxyprogesterone, or placebo. Oligomenorr heic subjects were randomized to receive medroxyprogesterone or placeb o. Bone mineral was measured by dual-energy x-ray absorptiometry at ba seline and at 6 and 12 months. RESULTS: In amenorrheic subjects spine and total body bone mineral measurements at 12 months were greater in the oral contraceptive group than in the medroxyprogesterone and place bo groups when baseline bone mineral measurements, body weight, and ag e were controlled for (p less than or equal to 0.05). There were no di fferences in hip bone mineral calcium and bone mineral density measure ments at 12 months among the three groups. In oligomenorrheic subjects there was no detectable improvement in bone mineral associated with m edroxyprogesterone use. CONCLUSIONS: This study supports the hypothesi s that oral contraceptive use in women with hypothalamic amenorrhea wi ll improve lumbar spine and total body bone mineral.