Journal of Bone and Mineral Metabolism

, Volume 37, Issue 1, pp 171–178 | Cite as

Decreased bone mineral density in women with Sheehan’s syndrome and improvement following oestrogen replacement and nutritional supplementation

  • Purnima Agarwal
  • Ramesh Gomez
  • Eesh Bhatia
  • Subhash YadavEmail author
Original Article


Sheehan’s syndrome (SS) is an important cause of pan-hypopituitarism in women. There is scanty information on bone mineral density (BMD) in this condition. We determined BMD and the changes in BMD after oestrogen (E2) replacement and nutritional supplementation in women with SS. In a cross-sectional study, BMD was measured by DEXA in 83 patients [age (mean ± SD) 42 ± 9.2 years] and compared with an equal number of matched controls. In a sub-set of 19 patients, we conducted an open-label, prospective study to determine changes in BMD after 1 year of replacement of E2, and calcium and vitamin D3 supplementation. All patients had low serum IGF-1 and E2, while 98% had ≥ 3 pituitary hormone deficiencies. Compared with Indian reference standards, 47% had decreased bone mass (Z-score ≤ − 2.0). BMD Z-scores were decreased at all sites, being most marked in the lumbar spine and femoral neck. At the lumbar spine, BMD was lowest among the age group 21–30 years. Women with SS also had significantly lower BMD Z-scores at all three sites on comparison with ethnic controls. On multivariate analysis, BMD Z-score was associated with weight, daily calcium intake and age (lumbar spine). In the prospective study, 1 year of therapy improved BMD Z-score at lumbar spine (− 1.4 ± 1.2 vs. − 1.1 ± 1.1, p = 0.02), but not at hip or femoral neck. In conclusion, patients with SS had significantly lower BMD compared to controls at all three sites. Replacement of E2 and supplementation with calcium/vitamin D3 lead to significant improvement in lumbar spine BMD.


Sheehan’s syndrome Bone mineral density Hypopituitarism Replacement therapy 



The financial support provided by Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, (PGI/DIR/RC/717/2011) as an intra-mural grant to Dr SB Yadav is acknowledged.

Compliance with ethical standards

Conflict of interest

All authors have no conflicts of interest.

Ethical approval

The studies have been approved by the appropriate institutional and/or national research ethics committee and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

774_2018_911_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 13 kb)


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Copyright information

© The Japanese Society for Bone and Mineral Research and Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of EndocrinologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia

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