Effects of Add-Back Therapy on Bone Mineral Density and Pyridinium Crosslinks in Patients with Endometriosis Treated with Gonadotropin-Releasing Hormone Agonists

C H Gnoth, Christian Gnoth, Gnoth CH, Gödtke K, Katrin Gödtke, K Gödtke, G. Freundl, Freundl G, E. Godehardt, Godehardt E, Kienle E, E. Kienle
Gynecologic and obstetric investigation · 1999 · vol. 47(1) , pp. 37–41 · doi:10.1159/000010059 · PMID:9852390 · W2016453646
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Add-back therapy in patients treated with GnRHa for endometriosis protected bone mineral density and collagen resorption but reduced GnRHa efficacy, despite both groups showing symptom improvement.

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Abstract

Treatment of endometriosis with gonadotropin-releasing hormone agonists (GnRHa) is limited to 6 months because of possible adverse effects on bone metabolism. We designed a randomized, double-blind, placebo-controlled, prospective study of 27 patients with endometriosis who were given GnRHa with or without hormone add-back therapy (+ 20 microg of ethinyl estradiol with 0.15 mg desogestrel) designed to suppress the adverse effects of hypoestrogenism while preserving the efficacy of GnRHa. Both regimens showed significant improvements in endometriosis, dysmenorrhea, and pelvic pain; effects were significantly better in the GnRHa + placebo group. The GnRHa + placebo group had significantly higher serum calcium levels and a significantly higher loss of lumbar spine bone mineral density (BMD). Urinary levels of pyridinium crosslinks increased significantly in the GnRHa + placebo group, and declined to normal in the GnRHa + add-back group. The add-back therapy protects women taking GnRHas from severe loss of BMD and accelerated bone collagen resorption, but reduces the efficacy of the GnRHa.

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Condition tags

endometriosischronic_pelvic_paindysmenorrhea

MeSH descriptors

Amino Acids Bone Density Desogestrel Endometriosis Ethinyl Estradiol Leuprolide Amino Acids Calcium Calcium Calcium Desogestrel Double-Blind Method Endometriosis Ethinyl Estradiol Female Humans Leuprolide Leuprolide Pelvic Pain Pelvic Pain

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