皮膚投与HRTによる低骨密度治療の有効性(HRT via skin is best treatment for low bone density in women whose periods have stopped due to anorexia or exercise)

2026-02-10

2026-02-06 インペリアル・カレッジ・ロンドン(ICL)

英国のインペリアル・カレッジ・ロンドンの研究チームは、無月経(摂食障害や過度な運動が原因)となった女性の低骨密度に対して、**皮膚から投与するホルモン補充療法(経皮HRT)**が最も有効な治療法であることを明らかにした。従来、このような女性には経口避妊薬が用いられることが多かったが、骨密度の改善効果は限定的であることが問題視されていた。本研究では、エストロゲンを皮膚から補充することで、骨代謝により生理的な形で作用し、骨密度の有意な改善が得られることを示した。特に、若年女性やアスリート、神経性食欲不振症の患者において、安全かつ効果的に骨の健康を回復できる可能性が示され、臨床治療指針の見直しにつながる重要な成果とされている。

<関連情報>

機能性視床下部性無月経における骨密度改善のための薬理学的介入:ランダム化臨床試験の系統的レビューとネットワークメタアナリシス Pharmacological interventions to improve bone density in functional hypothalamic amenorrhea: a systematic review and network meta-analysis of randomized clinical trials

Agathoklis Efthymiadis,Konstantinos Tsikopoulo ,Edouard G Mills,Andrew Milne,Waljit S Dhillo,Ali Abbara,Alexander N Comninos
The Journal of Clinical Endocrinology & Metabolism Published::08 January 2026
DOI:https://doi.org/10.1210/clinem/dgag005

Abstract

Context

Women with functional hypothalamic amenorrhea (FHA) are at high risk of poor bone health. When lifestyle measures fail to restore menses, pharmacological interventions are needed for bone health, but comparative efficacy remains unclear.

Objective

To compare the efficacy of available pharmacological interventions to improve bone mineral density (BMD), in women with FHA, employing network meta-analysis (NMA).

Data sources

Medline, Embase, Emcare, Cochrane CENTRAL, ISRCTN, and ClinicalTrials.gov were searched up to 20 September 2025.

Study selection

Eligible randomized-controlled trials evaluated pharmacological interventions for lumbar spine (LS), femoral neck (FN), or total hip (TH) BMD in women with FHA. Two independent reviewers screened titles, abstracts, and texts.

Data Extraction

Two reviewers independently extracted data following the Preferred Reporting Items for Systematic Reviews-network meta-analysis guidelines. Outcomes were expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs) using random-effects NMA. Evidence certainty was assessed with CINeMA.

Data Synthesis & Results

Thirteen randomized-controlled trials (n = 897 participant observations across all pharmacotherapy comparisons) were included (LS BMD: n = 897; FN BMD: n = 370; TH BMD: n = 750). Transdermal hormone replacement therapy (HRT) was superior to control (placebo or no intervention) for LS BMD with SMD: 0.34 (0.03, 0.64) and FN BMD with SMD: 0.57 (0.04, 1.10). Oral HRT and the combined oral contraceptive pill (COCP) showed no significant benefit for any BMD site. Teriparatide was superior to transdermal HRT and COCP for LS BMD with SMDs: 1.48 (0.38, 2.59) and 1.75 (0.66, 2.83), but not FN or TH BMD.