Bone increase similar to estrogens, bisphosphonates, SERMs
“DHEA supplementation in older women, but not in men, improves spine BMD when co-administered with vitamin D and calcium.”—Edward Weiss, PhD
“The results of our study are very promising. Similar studies have demonstrated much smaller benefits for bone than we found. However, calcium and vitamin D deficiencies, which are present in half of older adults, may have prevented DHEA from improving bone density in the earlier studies,” said Dr. Weiss, who is associate professor of nutrition and dietetics at Saint Louis University’s Doisy College of Health Sciences and lead author of the study. “In our study, we supplemented all participants with calcium and vitamin D to ensure that deficiencies were not present. This may explain why our study showed more favorable effects on bone density.”According to the researchers, the increase in spinal bone density experienced by women in the test group who took DHEA for two years was comparable to results with oral estrogens, bisphosphonates, and selective estrogen receptor modulators.
The two-year randomized trial divided 55 men and 58 women, ages 65 to 75 years old, into two groups. The first group received the DHEA supplement (50 mg/day), vitamin D, and calcium for two years. The control group received a placebo, vitamin D, and calcium for the first year and then received the DHEA supplement the second year in place of the placebo.
After year 1, women in the DHEA group had an approximate 2% increase in spinal bone density, but those in the placebo group had no increase. After the second year, when both groups took the DHEA supplement, women in the test group experienced an additional 2% increase for a total of approximately 4%, while women who switched from placebo to DHEA also experienced an approximate 2& increase. Hip BMD did not improve in either group.
Men in both the test and control groups had a similar 1-2% increase in spinal bone density, probably due to the vitamin D and calcium supplements.
“DHEA supplementation in older women, but not in men, improves spine BMD when co-administered with vitamin D and calcium,” the researchers concluded.
DHEA for older women: Translating research into practice
The results of the study are promising for older women. According to Dr. Weiss, patients who achieve similar increases of 2 to 4% in spinal bone density with the help of medication experience a 30 to 50% reduction in risk of spine fractures.
The downside is that DHEA, which is widely available as an over-the-counter dietary supplement, produced “small but significant increases in circulating concentrations of estrogen, testosterone, and IGF-1—all of which may promote tumorigenesis—[so] individuals taking DHEA supplements long term may need to be monitored regularly for hormone-sensitive cancer,” the authors write.
Senior author Dennis T. Villareal, MD, told MSKreport.com, "Those with history of breast or prostate cancer probably should not [take DHEA]. It would be prudent to have regular mammogram in women and prostate exam and perhaps PSA in men while taking the supplement." Dr. Villareal is Associate Professor of Medicine in Washington University School of Medicine's Division of Geriatrics and Nutritional Science, St. Louis, Missouri.
“Although DHEA is generally considered safe for consumption at 50 mg per day, it increases estrogen and testosterone levels which in turn could increase cancer risk,” Dr. Weiss explained. “Therefore, DHEA supplementation should be avoided in men and women who have had cancer or who have a strong family history of cancer until further research can establish whether or not it is safe for these individuals.”
In fact, Senator Charles Grassley (R-IA) introduced legislation on March 19, 2009 that would limit access to DHEA in an effort to decrease the abuse of performance-enhancing drugs by minors. The "Dehydroepiandrosterone Abuse Reduction Act of 2009" would impose civil penalties for anyone knowingly selling, causing to sell, or conspiring to sell a product containing DHEA to any individual under 18 years old without a prescription. The legislation does not limit the ability of individuals to obtain a prescription for lawful use of DHEA.
Most professional sports leagues, the NCAA, and the Olympics also ban the use of DHEA.
Sen. Grassley said he was alarmed by the accessibility minors have to purchase and possibly abuse the drug for performance-enhancing purposes. "This is all the more reason to pass my bill which makes it tougher for young athletes to obtain these potentially dangerous drugs," he said.
The US Anti-Doping Agency along with the Coalition for Anabolic Steroid Precursor and Ephedra Regulation, which is comprised of the nation's leading medical, public health, and sports organizations, have endorsed the "Dehydroepiandrosterone Abuse Reduction Act of 2009" legislation. In addition to this legislation, Grassley has introduced legislation in previous Congresses that would add DHEA to the list of controlled substances.
In Canada, a prescription is required to buy DHEA, and it is a prohibited substance under the World Anti-Doping Code of the World Anti-Doping Agency, which now runs drug testing for cycling and other international sports.
Reference
1. Weiss EP, Shah K, Fontana L, et al. Dehydroepiandrosterone replacement therapy in older adults: 1- and 2-y effects on bone. Am J Clin Nutr 2009;89:1459-1467.
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