Estrogen Supplementation and Bone Health of Women with Cystic Fibrosis Open Access

Abstract

Cystic fibrosis-related bone disease (CFBD) affects 25% of adults with cystic fibrosis (CF). The cause of CFBD is multifactorial, but sex steroid deficiency likely plays a key role. National guidelines recommend treating sex steroid deficiency in women with CF who have low bone mineral density (BMD), but the role of estrogen in CFBD has not been well studied.  

In this retrospective cohort study, the association of estrogen supplementation and lumbar spine BMD was examined in women with CF and BMD assessed by dual-energy x-ray absorptiometry (DXA). Of the 145 women studied, 43 women were prescribed estrogen supplementation; the most common formulation was oral ethinyl estradiol. Exposure to estrogen supplementation was associated with lower lumbar spine BMD compared to no exposure to estrogen supplementation. Data from 104 subjects with multiple assessments of lumbar spine BMD were included in logistic regression models of estrogen supplementation exposure and other factors affecting CFBD for predicting increasing lumbar spine BMD. Subjects exposed to estrogen had an odds ratio of 0.607 (95% CI 0.253 – 1.456) of having increasing lumbar spine BMD compared to the subjects not exposed to estrogen. Findings were similar when adjusted for age, pancreatic insufficiency, vitamin D deficiency and body mass index. Findings were similar in sensitivity analysis excluding subjects who had used anti-osteoporosis therapy and younger subgroup examining DXAs obtained when subjects were less than 30 years old. However, in the older subgroup (between 30 and 50 years old), subjects exposed to estrogen supplementation had an odds ratio of 1.072 (95% CI 0.284, 4.046) of having increasing lumbar spine BMD compared to subjects not exposed to estrogen supplementation.  

Recent published literature raises concern that ethinyl estradiol, a synthetic estrogen commonly found in hormonal contraception, impairs bone accrual in premenopausal women at risk for low BMD. This study’s results further support these concerns. Estradiol, a physiologic estrogen, was only used by patients older than 50 years in this retrospective cohort study. Prospective studies are needed to examine different doses, routes and formulations of estrogen supplementation to understand the role of estrogen in treating and preventing CFBD.  

Table of Contents

INTRODUCTION: 1 

BACKGROUND: 4 

METHODS: 7 

RESULTS: 13 

DISCUSSION: 16 

REFERENCES: 21 

TABLES and FIGURES: 24 

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery
Keyword	estrogen bone mineral density cystic fibrosis women
Committee Chair / Thesis Advisor	Vin Tangpricha, MD PhD, Emory University
Committee Members	Matthew Magee, MPH PhD, Emory University Jessica Alvarez, RD PhD, Emory University

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