Oligoamenorrheic athletes (OAs) have lower bone mineral density (BMD) and greater impairment of bone microarchitecture, and therefore higher fracture rates compared to eumenorrheic athletes. Although improvements in areal BMD (aBMD; measured by dual-energy X-ray absorptiometry) in OAs have been demonstrated with transdermal estrogen treatment, effects of such treatment on bone microarchitecture are unknown. Here we explore effects of transdermal versus oral estrogen versus no estrogen on bone microarchitecture in OA. Seventy-five OAs (ages 14 to 25 years) were randomized to (i) a 100-μg 17β-estradiol transdermal patch (PATCH) administered continuously with 200 mg cyclic oral micronized progesterone; (ii) a combined 30 μg ethinyl estradiol and 0.15 mg desogestrel pill (PILL); or (iii) no estrogen/progesterone (NONE) and were followed for 12 months. Calcium (≥1200 mg) and vitamin D (800 IU) supplements were provided to all. Bone microarchitecture was assessed using high-resolution peripheral quantitative CT at the distal tibia and radius at baseline and 1 year. At baseline, randomization groups did not differ by age, body mass index, percent body fat, duration of amenorrhea, vitamin D levels, BMD, or bone microarchitecture measurements. After 1 year of treatment, at the distal tibia there were significantly greater increases in total and trabecular volumetric BMD (vBMD), cortical area and thickness, and trabecular number in the PATCH versus PILL groups. Trabecular area decreased significantly in the PATCH group versus the PILL and NONE groups. Less robust differences between groups were seen at the distal radius, where percent change in cortical area and thickness was significantly greater in the PATCH versus PILL and NONE groups, and changes in cortical vBMD were significantly greater in the PATCH versus PILL groups. In conclusion, in young OAs, bone structural parameters show greater improvement after 1 year of treatment with transdermal 17β-estradiol versus ethinyl estradiol-containing pills, particularly at the tibia. © 2019 American Society for Bone and Mineral Research.

中文翻译：

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雌激素替代对青春期和年轻成年少月经运动员骨骼几何结构和微结构的影响：一项随机试验。

与月经正常的运动员相比，月经稀发的运动员 (OAs) 骨密度 (BMD) 较低，骨微结构受损较大，因此骨折率较高。尽管经皮雌激素治疗已证明 OA 的面积 BMD（aBMD；通过双能 X 射线吸收测定法测量）有所改善，但此类治疗对骨微结构的影响尚不清楚。在这里，我们探讨了经皮雌激素与口服雌激素与无雌激素对 OA 骨微结构的影响。75 名 OA（年龄在 14 至 25 岁之间）被随机分配至 (i) 100 微克 17β-雌二醇透皮贴剂 (PATCH)，连续给予 200 毫克循环口服微粉化黄体酮；(ii) 30 微克乙炔雌二醇和 0.15 毫克去氧孕烯丸 (PILL) 的组合；或 (iii) 无雌激素/孕激素 (NONE) 并随访 12 个月。向所有人提供了钙（≥1200 mg）和维生素 D（800 IU）补充剂。在基线和 1 年时，在胫骨和桡骨远端使用高分辨率外周定量 CT 评估骨微结构。在基线时，随机分组在年龄、体重指数、体脂百分比、闭经持续时间、维生素 D 水平、BMD 或骨微结构测量方面没有差异。治疗 1 年后，在胫骨远端，PATCH 组与 PILL 组相比，总骨密度和小梁体​​积 BMD (vBMD)、皮质面积和厚度以及小梁数量的增加显着增加。与 PILL 和 NONE 组相比，PATCH 组的小梁面积显着减少。在桡骨远端观察到组间差异较小，其中皮层面积和厚度的百分比变化在 PATCH 组与 PILL 和 NONE 组中显着更大，并且皮质 vBMD 的变化在 PATCH 组与 PILL 组中显着更大。总之，在年轻的 OA 中，与含乙炔雌二醇的药丸相比，经皮 17β-雌二醇治疗 1 年后，骨骼结构参数显示出更大的改善，尤其是在胫骨处。© 2019 美国骨骼和矿物研究协会。