Persistent osteopenia in ballet dancers with amenorrhea and delayed menarche despite hormone therapy: A longitudinal study

Objective: To investigate the role of estrogen deprivation and replacement in amenorrheic and nonamenorrheic dancers on hormone therapy and calcium. Design: Clinical, placebo-controlled, randomized trial study. Setting: Healthy volunteers in an academic research environment. Patient(s): Fifty-five dancers (mean age: 22.0 ± 4.6, age at menarche: 14.7 ± 2.3 years), including 24 amenorrheics. Intervention(s): Amenorrheics were randomized in a controlled trial to receive placebo or Premarin, 0.625 mg for 25 days monthly, with Provera, 10 mg, for 10 of these 25 days (hormone therapy) for 2 years. These women were compared to normally menstruating controls. The study participants also received 1250 mg of calcium per day. Main outcome measure(s): Bone mineral density (BMD) measured at the foot, wrist, and lumbar spine. Result(s): Our overall results showed no difference in BMD between the treated or placebo groups, indicating that hormone therapy did not change or normalize BMD when compared to normals. Five patients (all on placebo) who resumed menses during the study showed an increase in BMD without normalization. Conclusion(s): These findings suggest that mechanisms other than hypoestrogenism may be involved with the osteopenia associated with exercise-induced amenorrhea.