Pharmacological interventions to improve bone density in functional hypothalamic amenorrhea: a systematic review and network meta-analysis of randomized clinical trials.

When lifestyle measures fail to restore menses, pharmacological interventions are needed for bone health, but comparative efficacy remains unclear.

当生活方式措施无法恢复月经时，需要药物干预以改善骨健康，但其相对有效性尚不明确。

Background

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

通过网络荟萃分析（NMA）比较现有药物干预措施在改善 FHA 女性骨密度（BMD）方面的疗效。

data_sources

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

检索了 Medline、Embase、Emcare、Cochrane CENTRAL、ISRCTN 和 ClinicalTrials.gov 数据库，截止日期为 2025 年 9 月 20 日。

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.

符合条件的随机对照试验评估了针对女性FHA患者的腰椎（LS）、股骨颈（FN）或全髋（TH）骨密度（BMD）的药物干预。

Two independent reviewers screened titles, abstracts, and texts.

两位独立的评审员对标题、摘要和文本进行了筛选。

data_extraction

Two reviewers independently extracted data following the Preferred Reporting Items for Systematic Reviews-network meta-analysisguidelines.

两位评审员独立地按照系统综述-网络荟萃分析报告首选条目指南提取数据。

Outcomes were expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs) using random-effects NMA.

结果以标准化均数差（SMDs）表示，并附有95%置信区间（CIs），使用随机效应网络荟萃分析（NMA）。

Evidence certainty was assessed with CINeMA.

证据的确定性是通过CINeMA进行评估的。

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).

数据综合与结果：纳入了13项随机对照试验（所有药物治疗比较中的897个参与者观察），包括腰椎骨密度（LS BMD: n = 897）、股骨颈骨密度（FN BMD: n = 370）和全髋骨密度（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).

经皮激素替代疗法（HRT）对于腰椎骨密度（LS BMD）优于对照组（安慰剂或无干预），标准化均数差（SMD）为0.34（95%置信区间0.03至0.64），对于股骨颈骨密度（FN BMD）同样优于对照组，SMD为0.57（95%置信区间0.04至1.10）。

Oral HRT and the combined oral contraceptive pill (COCP) showed no significant benefit for any BMD site.

口服激素替代疗法（HRT）和联合口服避孕药（COCP）对于任何骨密度测量部位均未显示出显著的益处。

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.

对于腰椎骨密度（LS BMD），特立帕肽优于经皮HRT和COCP，其标准化平均差异（SMDs）分别为1.48（0.38，2.59）和1.75（0.66，2.83），但对于股骨颈（FN）或全髋（TH）骨密度则无优势。

Conclusions

Transdermal HRT and teriparatide improve LS BMD in women with FHA, with transdermal HRT also improving FN BMD.

经皮HRT和特立帕肽均能改善女性FHA患者的腰椎骨密度（LS BMD），并且经皮HRT还能改善股骨颈骨密度（FN BMD）。

study_registration

PROSPERO (CRD42024576872).

PROSPERO (CRD42024576872).