Abstract：
It is widely known that estrogen has a fundamental role to play in skeletal homeostasis. In the most reductionist sense, the action of estrogen can be surmised as anti-resorptive. Estrogen prevents the break-down of bone. It therefore follows that estrogen deficiency states, such as the menopause and functional hypothalamic amenorrhoea (FHA), are often characterised by increased bone remodelling and disrupted skeletal homeostasis. FHA is the cessation of menstruation secondary to abnormal signalling between the hypothalamus and pituitary gland due to deficient pulsatile secretion of Gonadotrophin Releasing Hormone (GnRH). Functional hypothalamic amenorrhoea is frequently a consequence of women suffering with eating disorders. The development of FHA secondary to eating disorders is an evolutionary adaptive response to chronic metabolic energy deficiency. Fundamentally, preservation of life is biologically prioritised over dispensable physiological process such as reproduction. Consequently, the hypothalamic-pituitary-ovarian (HPO) axis fails, which disrupts menstrual function and ovulation, culminating in a state of estrogen deficiency. One of the most important and long-lasting deleterious consequences of FHA is disrupted skeletal homeostasis and bone loss. Estrogen replacement, most commonly in the form of combined hormone replacement therapy (HRT) or the combined oral contraceptive pill (COCP), is advised for women with an early menopause to prevent bone loss. Arguably, estrogen replacement should also be utilised in the context of FHA. However, the optimum estrogen regime for women with FHA remains under-researched and so management is not evidence-based.
摘要：
众所周知，雌激素在骨骼稳态中起着基本作用。在最简化的意义上，雌激素的作用可以被认为是抗再吸收的。雌激素可防止骨骼分解。因此，雌激素缺乏状态，如绝经和功能性下丘脑闭经（FHA），通常以骨重建增加和骨骼稳态破坏为特征。FHA是由于促性腺激素释放激素（GnRH）的脉冲分泌不足，下丘脑和垂体之间异常信号传导的月经停止。功能性下丘脑闭经通常是女性饮食失调的结果。进食障碍继发的FHA的发展是对慢性代谢能缺乏的进化适应性反应。从根本上说,在生物学上，生命的保存优先于可有可无的生理过程，如繁殖。因此,下丘脑-垂体-卵巢（HPO）轴失败，扰乱月经功能和排卵，最终导致雌激素缺乏。FHA的最重要和持久的有害后果之一是破坏骨骼稳态和骨丢失。雌激素替代,最常见的形式是联合激素替代疗法（HRT）或联合口服避孕药（COCP），建议女性更年期提前，以防止骨质流失。可以说,雌激素替代也应用于FHA.然而,FHA女性的最佳雌激素治疗方案仍未得到充分研究,因此管理没有证据.
