Effects of DHEA and Exercise on Strength and Function in Older, Frail Women

This study reaffirms that DHEA supplementation does not improve BMD nor bone turnover markers.

By Susan W. Ryan, DO

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Reference

Kenny AM, Boxer RS, Kleppinger A, Brindisi J, Feinn R, Burleson JA. Dehydroepiandrosterone combined with exercise improves muscle strength and physical function in frail older women. J Am Geriatr Soc. 2010;58:1707-1714.

Design

Double-blind, randomized, placebo-controlled trial

Participants

Ninety-nine women (mean age 76.6 +/- 6.0) with low sulfated DHEA (DHEAS) levels, low bone mass, and frailty

Intervention

Participants received 50 mg/day DHEA or placebo for 6 months; all received 630 mg/day calcium and 400 IU cholecalciferol. Women participated 90 minutes twice weekly in an exercise regimen.

Primary Outcome Measures

Hormone levels, bone mineral density (BMD), bone turnover markers, body composition, upper- and lower-extremity strength, and physical performance were measured before and after the study.

Key Findings

87 females (88%) completed 6 months. No significant change in BMD or bone turnover marker was noted. Those who received DHEA supplementation with exercise had gains in lower-extremity strength and improvement in Short Physical Performance Battery Score (composite score focusing on lower-extremity function). DHEA was associated with significant changes in all hormone levels, including DHEAS, estradiol, estrone, and testosterone, as well as decreases in sex-binding globulin levels.

Practice Implications

This study reaffirms that DHEA supplementation does not improve BMD nor bone turnover markers. The authors conclude that DHEA supplementation improves lower-extremity strength and function in older, frail women involved in gentle exercise when in fact it is not demonstrated that the supplementation of DHEA had any material impact on performance. Other studies have demonstrated no effect of DHEA on exercise groups.1 While exercise has been well documented to have beneficial improvements in numerous ways, including measurements of biophysical markers and strength, flexibility, and functionality, this study does not provide clear evidence that DHEA supplementation can account for any improvements alone in performance. In this study, it was found that DHEA supplementation combined with exercise in women selected for low DHEAS levels improved lower-extremity muscle strength, which translated to improvement in lower-extremity physical performance.

DHEA supplementation does not consistently improve BMD at all skeletal sites or body composition.

DHEA supplementation does not consistently improve BMD at all skeletal sites or body composition.2,3,4 DHEA supplementation alone for 2 years had no meaningful physiological impact on postmenopausal body composition,5,6 nor did it have any impact on muscle size or strength.7,8 In fact, a study has shown that improvement in strength and physical function only occurred after adding high-resistance training to groups taking supplemental DHEA.9

Further studies need to be completed to evaluate the actual contribution of DHEA supplementation to strength and physical performance over the known benefits of exercise alone.

About the Author

Susan W. Ryan, DO, received her medical degree from The College of Osteopathic Medicine of the Pacific in Pomona, California. She completed a residency in family medicine and a sports medicine fellowship and is board certified in both areas. She has served as a team physician for collegiate, Olympic, and professional athletes in a multitude of sports. She actively teaches residents and medical students while practicing emergency medicine at Rose Medical Center in Denver, Colorado. She has contributed a chapter to The Encyclopedia of Sports Medicine: Women in Sport as well as written numerous articles and given lectures about exercise and medicine.

References

1. Igwebuike A, Irving BA, Bigelow ML et al. Lack of dehydroepiandrosterone effect on a combined endurance and resistance exercise program in postmenopausal women. J Clin Endocrinol Metab. 2008;93:534-538.

2. Jankowski CM, Gozansky WS, Schwartz RS, et al. Effects of dehydroepiandrosterone replacement therapy on bone mineral density in older adults: a randomized, controlled trial. J Clin Endocrinol Metab. 2006;91:2986-2993.

3. von Muhlen D, Laughlin GA, Kritz-Silverstein D, et al. The Dehydroepiandrosterone And WellNess (DAWN) study: research design and methods. Contemp Clin Trials. 2007;28:153-168.

4. Morales AJ, Haubrich RH, Hwang JY, et al. The effect of six months treatment with a 100 mg daily dose of dehydroepiandrosterone (DHEA) on circulating sex steroids, body composition and muscle strength in age-advanced men and women. Clin Endocrinol (Oxford). 1998;49:421-432.

5. Nair KS, Rizza RA, O’Brien P, et al. DHEA in elderly women and DHEA or testosterone in elderly men. N Engl J Med. 2006;355:1647-1659.

6. Morales AJ, Haubrich RH, Hwang JY, et al. The effect of six months treatment with a 100 mg daily dose of dehydroepiandrosterone (DHEA) on circulating sex steroids, body composition and muscle strength in age-advanced men and women. Clin Endocrinol (Oxford). 1998;49:421-432.

7. Dayal M, Sammel MD, Zhao J, et al. Supplementation with DHEA: effect on muscle size, strength, quality of life, and lipids. J Women's Health (Larchmt). 2005;14:391-400.

8. Morales AJ, Haubrich RH, Hwang JY, et al. The effect of six months treatment with a 100 mg daily dose of dehydroepiandrosterone (DHEA) on circulating sex steroids, body composition and muscle strength in age-advanced men and women. Clin Endocrinol (Oxford). 1998;49:421-432.

9. Villareal DT, Holloszy JO. DHEA enhances effects of weight training on muscle mass and strength in elderly women and men. Am J Physiol Endocrinol Metab. 2006;291:E1003-E1008.