Impact of Route of Estrogen Administration on Bone Turnover Markers in Oligoamenorrheic Athletes and its Mediators.

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Impact of Route of Estrogen Administration on Bone Turnover Markers in Oligoamenorrheic Athletes and its Mediators.

J Clin Endocrinol Metab. 2018 Nov 23;:

Authors: Singhal V, Ackerman KE, Bose A, Torre Flores LP, Lee H, Misra M

Abstract
Objective: Transdermal, but not oral, estrogen replacement improves bone mineral density (BMD) in athletes with oligo-amenorrhea (OA). Our objective was to determine mechanisms that may explain the impact of route of estrogen administration on bone outcomes.
Methods: 73 OA between 14-25 years old received (i) a 17β-estradiol transdermal patch continuously with cyclic oral micronized progesterone (PATCH), (ii) a combined ethinyl estradiol and desogestrel pill (PILL), or (iii) no estrogen/progesterone (NONE) for 12-months. We evaluated morning fasting levels of a marker of bone formation [N-terminal propeptide of type 1 procollagen (P1NP)], a marker of bone resorption [N-telopeptide (NTX)], insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein 3 (IGFBP3), total testosterone, estradiol, sex hormone-binding globulin (SHBG), sclerostin, preadipocyte factor-1 (Pref-1), brain-derived neurotrophic factor (BDNF), calcium, 25(OH) vitamin D, and parathyroid hormone (PTH) levels at baseline and 12-months.
Results: Groups did not differ for age, weight, exercise activity or markers of bone formation at baseline. Over 12 months, P1NP decreased the most in PILL group (p=0.03) associated with a decrease in IGF-1 levels (r=0.37; p=0.003). Sclerostin, Pref-1 and BDNF decreased in the PATCH group over 12 months. PATCH had the greatest increases in estradiol (p=<0.0001), and estradiol increases were associated with increases in bone density.
Conclusion: Transdermal 17β-estradiol given over 12 months does not cause the decrease in IGF-1 observed with oral ethinyl estradiol. It also leads to decreases in sclerostin, Pref-1 and BDNF, which may mediate the beneficial effects of estrogen.

PMID: 30476179 [PubMed - as supplied by publisher]

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