Pharmacological interventions to improve bone density in functional hypothalamic amenorrhea: a systematic review and network meta-analysis of randomized clinical trials - Summary - MDSpire
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Pharmacological Strategies for Enhancing Bone Density in Functional Hypothalamic Amenorrhea: A Systematic Review and Network Meta-Analysis of Randomized Trials
To compare the efficacy of pharmacological interventions for improving bone mineral density (BMD) in women with functional hypothalamic amenorrhea (FHA), addressing treatment gaps.
Key Findings:
Transdermal hormone replacement therapy (HRT) improved lumbar spine BMD (SMD: 0.34) and femoral neck BMD (SMD: 0.57) compared to control, based on two trials.
Oral HRT and combined oral contraceptive pill (COCP) showed no significant benefit for any BMD site across multiple trials.
Teriparatide was superior to transdermal HRT and COCP for lumbar spine BMD (SMDs: 1.48 and 1.75, respectively), but not for femoral neck or total hip BMD.
Interpretation:
Transdermal HRT and teriparatide are effective in improving lumbar spine BMD in women with FHA, with transdermal HRT also benefiting femoral neck BMD, suggesting a need for clinical adoption.
Limitations:
Evidence for transdermal HRT is based on only two randomized-controlled trials.
Low certainty in recommendations for COCP use due to lack of prospective studies.
Potential biases in the included studies may affect the reliability of findings.
Conclusion:
There is a critical need for more robust evidence to guide pharmacological treatment recommendations for bone health in women with FHA.
Patients with preoperative vitamin D deficiency had higher postoperative pain scores and opioid use after mastectomy, including more than triple the odds of moderate to severe pain within 24 hours of surgery.
