Persistent osteopenia in ballet dancers with amenorrhea and delayed menarche despite hormone therapy: a longitudinal study  Michelle P Warren, MD, Jeanne Brooks-Gunn, PhD, Richard P Fox, PhD, Claire C Holderness, MD, Emily P Hyle, BA, William G Hamilton, MD, Linda Hamilton, PhD  Fertility and Sterility  Volume 80, Issue 2, Pages 398-404 (August 2003) DOI: 10.1016/S0015-0282(03)00660-5

FIGURE 1 Bone mineral density over a 2-year period with hormone therapy ± SE. Spine BMD, P<.01, normals versus treated and placebo. • Amenorrheic on estrogen-progestin treatment (n = 13, 12, 9, 10, 6). ■ Amenorrheic on placebo (n = 11, 8, 7, 7, 7). ♢ Normal (n = 31, 25, 17, 16, 13). Warren. Osteopenia with amenorrhea and hormone therapy.Fertil Steril 2003. Fertility and Sterility 2003 80, 398-404DOI: (10.1016/S0015-0282(03)00660-5)

FIGURE 2 Spine bone mineral density of the six patients followed for 6 years. Open symbols denote normal patients, and solid symbols denote amenorrheics (d/c = discontinued). □ Age 12 years at menarche, started study at 29 years. ▵ Age 12 years at menarche, started study at 26 years. * Age 19 years at menarche, started study at 24 years. ○ Age 15 years at menarche, started study at 23 years. • Age 17 years at menarche, started study at 20 years (placebo); in year 4 gained 20 lbs (104→124). ▴ Age 16 years at menarche, started study at 19 years (HRT). Warren. Osteopenia with amenorrhea and hormone therapy.Fertil Steril 2003. Fertility and Sterility 2003 80, 398-404DOI: (10.1016/S0015-0282(03)00660-5)