In the Journals

DHEA in combination with vitamin D, calcium supplementation improved BMD in older women

Dehydroepiandrosterone in combination with vitamin D and calcium supplementation improved spine bone mineral density by about 4% in older women.

“Our data provide compelling evidence to suggest that older women with osteoporosis or those at high risk for developing osteoporosis should discuss with their physicians the possibility of taking a 50-mg per day DHEA supplement to improve bone health,” Edward Weiss, PhD, associate professor of nutrition and dietics at Doisy College of Health Sciences at Saint Louis University, told Endocrine Today.

Weiss and colleagues randomly assigned 55 men and 58 women aged 65 to 75 years to either 50-mg DHEA oral supplement daily or placebo for one year. By year two, all participants were assigned to open-label 50-mg DHEA supplement daily. In addition, all participants were assigned to daily vitamin D (16 mcg) and calcium (700 mg) supplements.

Spine BMD increased in women in the DHEA supplement group by 1.8% (P=.0003) during the first year and by 3.6% after two years. Spine BMD did not change in women in the placebo group during the first year but increased during the second year by 2.6% after crossover to DHEA supplementation.

The researchers also observed an increase in testosterone, estradiol and insulin-like growth factor I among participants in the DHEA supplement group only.

No significant differences were observed in spine BMD or bone turnover markers in men during the one-year study period. However, lumbar spine BMD significantly increased in both groups of men after two years (about 1.6%).

Further, hip and whole body BMD did not change among men or women.

“Certainly, there is the concern that because DHEA supplements increase testosterone and estrogen levels that they may increase cancer risk, and this is one of the main reasons why it is important for people to discuss DHEA supplementation with their doctor — especially those with a personal or family history of cancer,” Weiss said. “However, to date, five randomized clinical trials of one to two years of DHEA supplementation have been published, and none of these have linked DHEA with cancer risk.” – by Jennifer Southall

Weiss EP. Am J Clin Nutr. 2009;89:1459-1467.

PERSPECTIVE

This paper suggests that the androgen DHEA, which is available without prescription, improves spine BMD in women but not men. The authors attempted to uncover the effect of DHEA on bone turnover, but there were no significant differences in bone markers in the placebo vs. treatment groups and, for that reason, the way that the DHEA might have caused this effect remains unclear and the lack of effect in men most likely is related to their higher levels of androgen. A separate study using DHEA in men with very low levels of androgen would be interesting. The study further reveals that more than 50% of the people in the study were vitamin D-deficient at the beginning of the study, possibly even more using the new (higher) lower limits of normal. This fact serves as a reminder of how important it is to screen for vitamin D deficiency. The real questions that need to be answered are these: what is the quality of trabecular bone in women taking DHEA and is this treatment (along with calcium, vitamin D, and physical activity) sufficient to reduce fracture risk in those individuals whose t-scores or 10-year fracture risk scores (FRAX) require that medication be prescribed? Also, are women taking androgen less likely to fall? This study was not designed to answer these very important questions.

Donald Bergman, MD

Endocrine Today Editorial Board member

Dehydroepiandrosterone in combination with vitamin D and calcium supplementation improved spine bone mineral density by about 4% in older women.

“Our data provide compelling evidence to suggest that older women with osteoporosis or those at high risk for developing osteoporosis should discuss with their physicians the possibility of taking a 50-mg per day DHEA supplement to improve bone health,” Edward Weiss, PhD, associate professor of nutrition and dietics at Doisy College of Health Sciences at Saint Louis University, told Endocrine Today.

Weiss and colleagues randomly assigned 55 men and 58 women aged 65 to 75 years to either 50-mg DHEA oral supplement daily or placebo for one year. By year two, all participants were assigned to open-label 50-mg DHEA supplement daily. In addition, all participants were assigned to daily vitamin D (16 mcg) and calcium (700 mg) supplements.

Spine BMD increased in women in the DHEA supplement group by 1.8% (P=.0003) during the first year and by 3.6% after two years. Spine BMD did not change in women in the placebo group during the first year but increased during the second year by 2.6% after crossover to DHEA supplementation.

The researchers also observed an increase in testosterone, estradiol and insulin-like growth factor I among participants in the DHEA supplement group only.

No significant differences were observed in spine BMD or bone turnover markers in men during the one-year study period. However, lumbar spine BMD significantly increased in both groups of men after two years (about 1.6%).

Further, hip and whole body BMD did not change among men or women.

“Certainly, there is the concern that because DHEA supplements increase testosterone and estrogen levels that they may increase cancer risk, and this is one of the main reasons why it is important for people to discuss DHEA supplementation with their doctor — especially those with a personal or family history of cancer,” Weiss said. “However, to date, five randomized clinical trials of one to two years of DHEA supplementation have been published, and none of these have linked DHEA with cancer risk.” – by Jennifer Southall

Weiss EP. Am J Clin Nutr. 2009;89:1459-1467.

PERSPECTIVE

This paper suggests that the androgen DHEA, which is available without prescription, improves spine BMD in women but not men. The authors attempted to uncover the effect of DHEA on bone turnover, but there were no significant differences in bone markers in the placebo vs. treatment groups and, for that reason, the way that the DHEA might have caused this effect remains unclear and the lack of effect in men most likely is related to their higher levels of androgen. A separate study using DHEA in men with very low levels of androgen would be interesting. The study further reveals that more than 50% of the people in the study were vitamin D-deficient at the beginning of the study, possibly even more using the new (higher) lower limits of normal. This fact serves as a reminder of how important it is to screen for vitamin D deficiency. The real questions that need to be answered are these: what is the quality of trabecular bone in women taking DHEA and is this treatment (along with calcium, vitamin D, and physical activity) sufficient to reduce fracture risk in those individuals whose t-scores or 10-year fracture risk scores (FRAX) require that medication be prescribed? Also, are women taking androgen less likely to fall? This study was not designed to answer these very important questions.

Donald Bergman, MD

Endocrine Today Editorial Board member