Add-back medrogestone does not prevent bone loss in premenopausal women treated with goserelin

Sillem M, Martin Sillem, M Sillem, Mohsen Parviz, Parviz M, M Parviz, Henning W. Woitge, H W Woitge, Woitge HW, Ludwig Kiesel, L Kiesel, Kiesel L, Ulrich U, U. Ulrich, Th. von Holst, von Holst T, T von Holst, B. Runnebaum, Runnebaum B, R. Ziegler, Ziegler R, M J Seibel, Markus J. Seibel
Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association · 2009 · vol. 107(06) , pp. 379–385 · doi:10.1055/s-0029-1212129 · PMID:10543415 · W2086841654
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Medrogestone did not prevent bone loss in premenopausal women treated with goserelin for endometriosis, though it altered bone turnover markers differently than placebo.

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This study evaluated the impact of medrogestone on bone mineral density and turnover markers in premenopausal women undergoing estrogen withdrawal via goserelin treatment. Participants received either placebo or 10 mg of medrogestone daily for six months, with bone measurements taken at baseline and after the intervention period. The results indicated that medrogestone failed to prevent significant lumbar spine bone loss compared to the placebo group, although it did alter bone turnover dynamics by suppressing initial markers and delaying their rise until treatment cessation. This paper is centrally about endometriosis — specifically, the management of this condition using GnRH analogues and the associated side effect of bone density reduction.

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Abstract

To investigate the effect of medrogestone on bone mineral density (BMD) and bone turnover under conditions of estrogen withdrawal, premenopausal women with endometriosis were treated with goserelin (Zoladex), combined with either placebo (group A, n = 12) or 10 mg medrogestone (Prothil, group B, n = 11) for six months, and followed for an additional six months. Lumbar spine BMD was measured at 0 and 6 month. Markers of bone turnover were serum bone alkaline phosphatase (sBAP) and osteocalcin (sOC) by ELISA, and urinary total pyridinoline (uPYD) and deoxypyridinoline crosslinks (uDPD) by HPLC. Patients in both groups had a similar and significant decrease in BMD after 6 months (4%, p < 0.01). The time course of changes in bone turnover, in contrast, was different in both groups. In group A, crosslink excretion increased from one month onwards, while no changes were seen in group B. In group A, sBAP levels rose during treatment, while in group B, this rise was delayed until treatment was terminated. Additionally, group B showed an initial suppression of sBAP and sOC. In both groups, sOC increased after treatment was discontinued. Medrogestone at 10 mg/d does not prevent lumbar bone loss in premenopausal women under estrogen deprivation. In the medrogestone add back group, the changes in bone turnover are compatible with low turnover bone loss,as ooposed to a state of high turnover seen in the unopposed goserelin group. This effect may be due to glucocorticoid receptor mediated actions of medrogestone on bone.
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Subscribe to RSS DOI: 10.1055/s-0029-1212129 © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York Add-back medrogestone does not prevent bone loss in premenopausal women treated with goserelin Publication History Publication Date: 14 July 2009 (online) Summary To investigate the effect of medrogestone on bone mineral density (BMD) and bone turnover under conditions of estrogen withdrawal, premenopausal women with endometriosis were treated with goserelin (Zoladex®), combined with either placebo (group A, n = 12) or 10 mg medrogestone (Prothil®, group B, n = 11) for six months, and followed for an additional six months. Lumbar spine BMD was measured at 0 and 6 month. Markers of bone turnover were serum bone alkaline phosphatase (sBAP) and osteocalcin (sOC) by ELISA, and urinary total pyridinoline (uPYD) and deoxypyridinoline crosslinks (uDPD) by HPLC. Patients in both groups had a similar and significant decrease in BMD after 6 months (4%, p < 0.01). The time course of changes in bone turnover, in contrast, was different in both groups. In group A, crosslink excretion increased from one month onwards, while no changes were seen in group B. In group A, sBAP levels rose during treatment, while in group B, this rise was delayed until treatment was terminated. Additionally, group B showed an initial suppression of sBAP and sOC. In both groups, sOC increased after treatment was discontinued. Medrogestone at 10 mg/d does not prevent lumbar bone loss in premenopausal women under estrogen deprivation. In the medrogestone add back group, the changes in bone turnover are compatible with low turnover bone loss, as ooposed to a state of high turnover seen in the unopposed goserelin group. This effect may be due to glucocorticoid receptor mediated actions of medrogestone on bone. Key words GnRH analogue - progestins - medrogestone - bone loss - bone turnover

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Condition tags

endometriosis

MeSH descriptors

Bone Remodeling Endometriosis Goserelin Medrogestone Premenopause Progesterone Congeners Adult Alkaline Phosphatase Alkaline Phosphatase Amino Acids Amino Acids Bone and Bones Bone and Bones Bone Density Double-Blind Method Endometriosis Endometriosis Female Goserelin Humans

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