Effect of transdermal estradiol therapy on bone mineral density of amenorrheic female athletes

Background The effects of transdermal estradiol treatment (HT) in amenorrheic athletes (AA) with low body weight (BW) and low bone mineral density (BMD) are unknown. Purpose To investigate whether HT increases BMD in AA with low BW and to compare the results with levels in AA who have recovered spontaneous menstruation (SM). Methods Female athletes (n = 151) were recruited at the Japan Institute of Sports Sciences and the University of Tokyo. All participants were divided into four groups: an AA group (untreated group) (n = 36), a HT group (n = 55), a SM group (n = 21), and an eumenorrheic athletes (EA) group (n = 39). Height, body weight, blood tests, and dual-energy X-ray absorptiometry were measured at baseline and after 12 months. The HT group was treated daily for 12 months with transdermal estrogen therapy. In addition, participants received oral progestin for 7 days once every 3 months. Results After 12 months, BMD in the AA group was significantly lower than at baseline; however, BMD in the other three groups was significantly higher than at baseline. The ratio of the change in BMD values before and after 12 months was -1.6 +/- 3.2% for the AA group, 5.3 +/- 8.7% for the HT group, 11.1 +/- 8.9% for the SM group, and 2.3 +/- 5.7% for the EA group. The rate of change in BMD values in the SM group was greater than that in the HT group. Conclusion HT increased BMD in AA with low BW, and the increase in those with SM was greater than that in those treated with HT.