title: Effects of add-back therapy on bone mineral density and pyridinium crosslinks in patients with endometriosis treated with gonadotropin-releasing hormone agonists.
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.
authors.affiliation: Department of Gynecology and Obstetrics, Academic Hospital of the University of Düsseldorf, Düsseldorf-Benrath, Germany. gnoth@uni-duesseldorf.de
authors.forename: C H
authors.initials: CH
authors.lastname: Gnoth
authors.forename: K
authors.initials: K
authors.lastname: Gödtke
authors.forename: G
authors.initials: G
authors.lastname: Freundl
authors.forename: E
authors.initials: E
authors.lastname: Godehardt
authors.forename: E
authors.initials: E
authors.lastname: Kienle
mesh_terms: D000596:Amino Acids / Q000652:urine*; D015519:Bone Density; D002118:Calcium / Q000097:blood / Q000652:urine; D017135:Desogestrel / Q000627:therapeutic use*; D004311:Double-Blind Method; D004715:Endometriosis / Q000188:drug therapy*; D004997:Ethinyl Estradiol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016729:Leuprolide / Q000009:adverse effects / Q000627:therapeutic use*; D017699:Pelvic Pain / Q000188:drug therapy; D010919:Placebos; D011446:Prospective Studies
chemical_list: D000596:Amino Acids; D010919:Placebos; D004997:Ethinyl Estradiol; C015484:pyridinoline; D017135:Desogestrel; D016729:Leuprolide; D002118:Calcium