***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Anorexia nervosa ( AN ) is prevalent in adolescents and is associated with decreased bone mineral accrual at a time critical for optimizing bone mass . Low BMD in AN is a consequence of nutritional and hormonal alterations , including hypogonadism and low estradiol levels . Effective therapeutic strategies to improve BMD in adolescents with AN have not been identified . Specifically , high estrogen doses given as an oral contraceptive do not improve BMD . The impact of physiologic estrogen doses that mimic puberty on BMD has not been examined . We enrolled 110 girls with AN and 40 normal-weight controls 12 to 18 years of age of similar maturity . Subjects were studied for 18 months . Mature girls with AN ( bone age [ BA ] ≥15 years , n = 96 ) were r and omized to 100 µg of 17β-estradiol ( with cyclic progesterone ) or placebo transdermally for 18 months . Immature girls with AN ( BA < 15 years , n = 14 ) were r and omized to incremental low-dose oral ethinyl-estradiol ( 3.75 µg daily from 0 to 6 months , 7.5 µg from 6 to 12 months , 11.25 µg from 12 to 18 months ) to mimic pubertal estrogen increases or placebo for 18 months . All BMD measures assessed by dual-energy X-ray absorptiometry ( DXA ) were lower in girls with AN than in control girls . At baseline , girls with AN r and omized to estrogen ( AN E + ) did not differ from those r and omized to placebo ( AN E- ) for age , maturity , height , BMI , amenorrhea duration , and BMD parameters . Spine and hip BMD Z-scores increased over time in the AN E+ compared with the AN E- group , even after controlling for baseline age and weight . It is concluded that physiologic estradiol replacement increases spine and hip BMD in girls with AN Introduction The aim of this study was the long-term prospect i ve evaluation of the effects of estroprogestagen ( EP ) therapy on the bone mineral density ( BMD ) of girls with functional hypothalamic amenorrhea ( FHA ) carrying various PvuII and XbaI polymorphisms of ER-α . Material and methods Prospect i ve observation included 84 FHA girls and 50 controls . The FHA patients were subjected to 4-year sequential therapy with 17β estradiol ( 2 mg from the 2nd to 25th day of the menstrual cycle ) and dydrogesterone ( 10 mg from the 16th to the 25th day ) . Hormonal parameters , serum concentration of the bone fraction of alkaline phosphatase ( BALP ) , urine concentration of cross-linked n-telopeptide of type I collagen ( Ntx ) and BMD were determined before and after the treatment . Results Six-month treatment result ed in a marked increase in estradiol ( p = 0.001 ) , testosterone and prolactin levels ( p = 0.01 both ) and a significant decrease in BALP and Ntx ( p = 0.001 both ) . Patients with the PP polymorphism had significantly lower baseline BMD compared to carriers of other polymorphic variants of PvuII ( p = 0.003 ) . A significant increase in BMD was observed throughout the entire therapy period , with no significant differences in the yearly dynamics of BMD changes observed amongst various polymorphic variants and haplotypes of ER-α . Conclusions The EP therapy is effective in the treatment of BMD disorders associated with FHA , and treatment results do not depend on PvuII and XbaI polymorphisms of ER-α Abstract : There is considerable concern about the adverse effects on the skeleton of loss of menstrual function as a result of athletic activity , as well as uncertainty as to how it should be managed clinical ly . In a pilot intervention study 34 elite middle and long-distance runners , aged 18–35 years , with menstrual irregularity due to their athletic activity were r and omized to three groups : ( A ) to receive hormone replacement therapy ( HRT ) and 1000 mg calcium per day ( n= 10 ) , ( B ) to receive 1000 mg calcium per day ( n = 14 ) , ( C ) a control group who received no treatment ( n= 10 ) . Bone mineral density ( BMD ) was measured in the left hip and lumbar spine ( L2–4 ) using dual-energy X-ray absorptiometry . Results were first analyzed according to whether menstruation returned , either naturally or secondary to HRT ( EU ) , and compared with those from subjects who remained amenorrheic ( AM ) . During the first year BMD increased in the EU group in Ward ’s triangle ( 3.8 % ) and the lumbar spine ( 4.1 % ; both P<0.05 ) . BMD fell in the AM group in all regions and the between-group differences were 5.6 % ( p<0.02 ) in Ward ’s triangle , 5.8 % ( p<0.02 ) in L2–4 and 3.9 % in the trochanter ( p<0.05 ) . An ‘ intention to treat ’ analysis was then performed . It was found that the mean relative improvement at 1 year in spinal BMD was only 1.5 % , due to return of menses in some of the controls and withdrawals from treatment in the treatment group . In consequence , a trial design ed to show , with 80 % power and 5 % significance , a measurable benefit in lumbar spine BMD result ing from allocation to HRT treatment would require about 1150 athletes with amenorrhea or oligomenorrhea . These numbers could be reduced substantially to 380 subjects by confining the trial to completely amenorrheic athletes , who in this study were less likely to regain menses . For these and other logistical reasons , an HRT trial in amenorrheic athletes could only be successfully organized through international collaboration . This study illustrates the major effects of treatment withdrawals and instability of menstrual status on the design of longitudinal studies on the bony effects of menstrual dysfunction prior to menopause Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE Osteoporosis is recognized as a common medical complication of anorexia nervosa ( AN ) . The purpose of the current study was to investigate the recovery mechanism of osteoporosis in AN and the effect of medical treatment on the skeletal system . METHOD We conducted a r and omized placebo-controlled study of the effects of etidronate and calcium and vitamin D on bone loss in 41 out patients with the restricting type of AN ( AN-R ) . We measured the tibial speed of sound ( SOS ) before and after 3 months of treatment . RESULTS The bone mineral density ( BMD ) of the tibial SOS change in both the etidronate group and the calcium and vitamin D Group was significantly greater ( p < .001 ) than in the control group . Urine-N-telopeptide cross-links of type I collagen ( NTx ) before and after treatment decreased significantly ( p < .01 ) in the etidronate group . CONCLUSION These findings suggest that both etidronate and calcium and vitamin D are equally efficacious for reversing the degree of osteoporosis in patients with AN OBJECTIVES The objectives of this study were to assess ( 1 ) whether treatment with oral contraceptives , in comparison with medroxyprogesterone and placebo , improved bone mineral in women with hypothalamic amenorrhea and ( 2 ) whether treatment with medroxyprogesterone , in comparison with placebo , improved bone mineral in women with hypothalamic oligomenorrhea . STUDY DESIGN The study was a r and omized , controlled clinical trial . Twenty-four white women , aged 14 to 28 years , with hypothalamic amenorrhea or oligomenorrhea were prospect ively enrolled for a 12-month intervention period . Amenorrheic subjects were r and omized to receive oral contraceptives , medroxyprogesterone , or placebo .  Oligomenorrheic subjects were r and omized to receive medroxyprogesterone or placebo .  Bone mineral was measured by dual-energy x-ray absorptiometry at baseline and at 6 and 12 months . RESULTS In amenorrheic subjects spine and total body bone mineral measurements at 12 months were greater in the oral contraceptive group than in the medroxyprogesterone and placebo groups when baseline bone mineral measurements , body weight , and age were controlled for ( p < or = 0.05 ) . There were no differences in hip bone mineral calcium and bone mineral density measurements at 12 months among the three groups . In oligomenorrheic subjects there was no detectable improvement in bone mineral associated with medroxyprogesterone use . CONCLUSIONS This study supports the hypothesis that oral contraceptive use in women with hypothalamic amenorrhea will improve lumbar spine and total body bone mineral CONTEXT Anorexia nervosa is complicated by severe bone loss and clinical fractures . Mechanisms underlying bone loss in adults with anorexia nervosa include increased bone resorption and decreased formation . Estrogen administration has not been shown to prevent bone loss in this population , and to date , there are no approved , effective therapies for this comorbidity . OBJECTIVE To determine whether antiresorptive therapy with a bisphosphonate alone or in combination with low-dose transdermal testosterone replacement would increase bone mineral density ( BMD ) in women with anorexia nervosa . DESIGN AND SETTING We conducted a12-month , r and omized , placebo-controlled study at a clinical research center . STUDY PARTICIPANTS Participants included 77 ambulatory women with anorexia nervosa . INTERVENTION Subjects were r and omized to risedronate 35 mg weekly , low-dose transdermal testosterone replacement therapy , combination therapy or double placebo . MAIN OUTCOME MEASURES BMD at the spine ( primary endpoint ) , hip , and radius and body composition were measured by dual-energy x-ray absorptiometry . RESULTS Risedronate  increased posteroanterior spine BMD 3 % , lateral spine BMD 4 % , and hip BMD 2 % in women with anorexia nervosa compared with placebo in a 12-month clinical trial . Testosterone administration did not improve BMD but increased lean body mass . There were few side effects associated with either therapy . CONCLUSIONS Risedronate administration for 1 yr increased spinal BMD , the primary site of bone loss in women with anorexia nervosa . Low-dose testosterone did not change BMD but increased lean body mass Anorexia nervosa ( AN ) , a psychiatric disease characterized by chronic starvation , is complicated by severe bone loss ( 1 ) , for which there is no effective , available therapy . Although bone resorption is markedly increased in these patients , estrogen is an ineffective anti-resorptive therapy in the setting of undernutrition . We hypothesized bisphosphonate administration would result in a decrease in bone resorption and an increase in bone density in women with AN and bone loss , despite undernutrition . We therefore administered risedronate 5 mg daily for nine months to 10 women with AN , all of whom had osteopenia ( mean AP spine T score : -2.7 + /- 2 ) and compared NTX and bone density with baseline values and with those from available control data prospect ively followed for the same time period . Bone density increased significantly in patients who received risedronate compared with controls and compared with baseline , despite lack of significant weight gain , for an increase of AP spine bone density of 4.1 + /- 1.6 % at six months and 4.9 + /- 1.0 % at nine months . Bone resorption , as measured by NTX , decreased 23.8 % at one month and 29.6 % at three months , from the high-normal to mid-normal range of young women . Our data suggest that risedronate 5 mg daily administered to women with AN and osteopenia may increase in bone density at the AP spine despite low weight . This is the first study to demonstrate marked increases in bone density in women with AN . Because of the lack of data regarding the safety of such medications in women of reproductive age , bisphosphonates are not approved in the U.S. for premenopausal women other than those receiving glucocorticoids . Further studies are needed to establish the efficacy and safety of bisphosphonate therapy in this population OBJECTIVE To evaluate whether decreasing doses of ethinyl estradiol affect bone loss related to hypothalamic amenorrhea . STUDY DESIGN Sixty-four women with hypothalamic oligoamenorrhea were allocated to two therapy groups : group A ( n = 24 ) received an OC containing 0.030 mg of ethinyl estradiol ( EE ) and 0.15 mg of desogestrel . Group B ( n = 22 ) received an OC containing 0.020 mg of EE and 0.15 mg of desogestrel .  Eighteen women who did not wish to use hormonal therapy constituted the control group ( C ) .  Calcium , phosphate and osteocalcin were measured basally and at 6 and 12 months of follow-up . Bone mineral density at the lumbar spine was determined before initiation of the study and at 12 months by dual energy X-ray absorptiometry . RESULTS Serum calcium , phosphate and osteocalcin were significantly reduced by both active treatment reg 
    Output:
    
There was no substantial effect of receiving hormonal therapy on BMD of the femoral neck , trochanteric region , Ward triangle , or total body BMD .
Conclusion The current evidence does not support using hormonal therapy for the sole purpose of improving bone health in patients with FHA .
There are no data about bisphosphonates in this population