Reversible bone loss in women treated with GnRH-agonists for endometriosis and uterine leiomyoma
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GnRH-agonist treatment for endometriosis and uterine leiomyoma caused reversible bone loss and altered calcium metabolism, with cortical bone remaining unaffected.
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Abstract
Oestrogen deficiency at the menopause is associated with changes in calcium and bone metabolism. Hypo-oestrogenism induced by the use of GnRH-agonists is clinically useful in the treatment of oestrogen-dependent diseases. This study was done to investigate calcium homeostasis and bone metabolism of pre-menopausal women in a GnRH-agonist-induced pseudo-menopause. Eighteen patients with endometriosis or uterine leiomyoma received monthly i.m. injections of 3.2 mg of long-acting D-Trp-6-LHRH over a 6-month period. Plasma oestradiol-17 beta and progesterone levels under treatment were significantly decreased to the levels of the early follicular phase. Plasma total calcium, serum osteocalcin and plasma alkaline phosphatase concentrations increased, while plasma phosphate levels did not change. Levels of 1,25-dihydroxyvitamin D3 decreased significantly, but 25-hydroxyvitamin D3 values remained constant. Trabecular bone mineral density of lumbar spine decreased continuously during the 6-month period. Nine women completed 6-9 months follow-up. In these women bone loss was reversible. Cortical bone measurements at the proximal radius showed no change during oestrogen deficiency. In conclusion, our findings demonstrate that GnRH-agonist-induced bone loss is reversible. Furthermore, they suggest that the state of pseudo-menopause induced by GnRH-agonist may serve as a model for further pathophysiological studies on calcium homeostasis and bone metabolism in the post-menopause.
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Cited by (20)
- Lipid Profile after Pharmacologic Discontinuation and Restoration of Menstruation in Women with Endometriosis: A 12-Month Observational Prospective Study 2023
- The effect of pharmacological cessation and restoration of menstrual cycle on bone metabolism in premenopausal women with endometriosis 2022
- Gonadotropin-Releasing Hormone and Its Analogues 2020
- Gonadotropin releasing hormone agonists: Expanding vistas 2011
- Bone metabolism in postmenopausal women who were treated with a gonadotropin-releasing hormone agonist and tibolone 2002
- Long-term use of gonadotropin-releasing hormone analogs and hormone replacement therapy in the management of endometriosis: a randomized trial with a 6-year follow-up 2000
- Modern Approach to Endometriosis 1997
- Reduction of bone mineral density by gonadotropin‐releasing hormone agonist, nafarelin, is not completely reversible at 6 months after the cessation of administration 1996
- Spontaneous reversibility of bone loss induced by gonadotropin-releasing hormone analog treatment 1996
- Spontaneous reversibility of bone loss induced by gonadotropin-releasing hormone analog treatment. 1996
- Multiple Polypoid Endometriosis‐A Rare Complication Following Withdrawal of Gonadotrophin Releasing Hormone (GnRH) Agonist for Severe Endometriosis: A Case Report 1996
- Long-acting triptorelin for the treatment of endometriosis 1996
- Impact of different GnRH analogs in benign gynecological disorders related to their chemical structure, delivery systems and dose 1994
- Cutaneous and Subcutaneous Endometriosis 1994
- Nafarelin therapy in endometriosis: Long-term effects on bone mineral density 1994
- MANAGEMENT OF ENDOMETRIOSIS IN WOMEN OLDER THAN 40 YEARS OF AGE 1993
- The effect of a synthetic GnRH analogue on catamenial epilepsy: a study in ten patients 1992
- Severe endometriosis treated with gonadotrophin releasing hormone agonist and continuous combined hormone replacement therapy 1992
- Gonadotropin-Releasing Hormone and Its Analogues 1991
- The impact of treatment on the natural history of endometriosis 1990
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