What is the best strategy to combat low bone mineral density in functional hypothalamic amenorrhea?

Abstract

Functional hypothalamic amenorrhea (FHA) is associated with low BMD and decreased rates of bone mass accrual, particularly in conditions of severe undernutrition, such as anorexia nervosa. In addition to immediate fracture risk, the finding of impaired bone metabolism in young women raises concerns about reduced peak bone mass, an important determinant of bone health in later life. Appropriate treatment of FHA is, therefore, crucial for restoration of BMD and for bone mass accrual. Vescovi et al. have performed a systematic review of the literature in order to assess therapeutic strategies that aim to reverse bone loss in women with FHA. In this Practice Point commentary, I discuss the extent to which hormonal and nonhormonal therapies have, or have not, been beneficial in optimizing bone health. In addition, I emphasize the importance of weight gain and recovery of reproductive function in the preservation of bone health in women with FHA.