The effects of gonadotrophin-releasing hormone agonists on iliac crest cancellous bone structure in women with endometriosis.
The administration of gonadotrophin-releasing hormone (GnRH) analogs to premenopausal women causes hypoestrogenism and bone loss, but the effects on cancellous microstructure have not been determined. In this study we have assessed bone structure in transiliac biopsies obtained from women before and after treatment for endometriosis with GnRH analogs. Twenty-one premenopausal women were studied, paired biopsies being obtained in 13; five women received both GnRH analogs and Org OD 14 (Tibolone, Livial). Comparison of pre- and post-treatment biopsies in women treated only with GnRH analogs showed a reduction in indices related to connectivity (node-to-terminus ratio, node-to-loop strut length, p < 0.02) and increase in inversely related indices (terminus-to-terminus and node-to-terminus strut length, p < 0.03). No significant changes were seen in any of the structural indices in women receiving both GnRH and Org OD 14 therapy. Activation frequency and bone formation rate at tissue level increased in women treated with GnRH agonists alone, although this change was not statistically significant. Our results suggest that bone loss induced by GnRH analogs may be associated with adverse effects on cancellous microstructure which are unlikely to be reversed following cessation of therapy. Concurrent treatment with Org OD 14 appears to prevent these changes.
Compston
J E
JE
Department of Medicine, University of Cambridge Clinical School, Addenbrooke's Hospital, UK.
Yamaguchi
K
K
Croucher
P I
PI
Garrahan
N J
NJ
Lindsay
P C
PC
Shaw
R W
RW
D000328:Adult; D045930:Anabolic Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001706:Biopsy; D015519:Bone Density / Q000187:drug effects*; D001862:Bone Resorption / Q000139:chemically induced; D004359:Drug Therapy, Combination; D004715:Endometriosis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D017273:Goserelin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007085:Ilium / Q000187:drug effects / Q000473:pathology / Q000648:ultrastructure; D009652:Norpregnenes / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D015663:Osteoporosis, Postmenopausal / Q000517:prevention & control; D017697:Premenopause; D017329:Triptorelin Pamoate / Q000009:adverse effects / Q000627:therapeutic use
D045930:Anabolic Agents; D009652:Norpregnenes; D017329:Triptorelin Pamoate; D017273:Goserelin; D007987:Gonadotropin-Releasing Hormone; C027385:tibolone