Bone metabolism in postmenopausal women who were treated with a gonadotropin-releasing hormone agonist and tibolone.
OBJECTIVE
To study the bone metabolism in postmenopausal women who have been treated with gonadotropin-releasing hormone agonist (GnRH-a) and tibolone.


METHODS
Prospective, open, controlled clinical trial.


METHODS
Department of Gynecology and Obstetrics, University of Catanzaro, Catanzaro, Italy.


METHODS
One hundred twenty perimenopausal women with symptomatic uterine leiomyomas (groups A and B), and 40 healthy control women who underwent a normal spontaneous menopause (group C).


METHODS
Treatment for 12 months with leuprolide acetate plus tibolone (group A) or hysterectomy with bilateral oophorectomy (group B).


METHODS
Lumbar spine bone mineral density (BMD) and bone turnover markers at entry into the study, after medical treatment (only group A), and 12 months after discontinuation medical treatment (group A) or after surgery (group B). The same parameters were noted in healthy women before and 12 months after menopause (retrospective control group, group C).


RESULTS
At the women's entry into the study, no significant difference in BMD and bone turnover markers was detected between groups A and B. In group A, no significant variation in BMD or bone turnover markers was observed 12 months after medical treatment in comparison with baseline. At 12 months after discontinuation of treatment (in women who had achieved menopause) and after surgery, we observed a statistically significant decrease in BMD and in bone turnover markers in both groups in comparison with baseline. At 12 months after they became menopausal, we also observed a statistically significant reduction in BMD and in bone turnover markers in control group C. At the same 12-month follow-up visit, a statistically significant difference in BMD and in bone turnover markers was detected when comparing groups A and B with group C.


CONCLUSIONS
Women previously treated with GnRH-a and tibolone similar to women who are menopausal as a result of surgery, have higher bone loss after menopause.
Palomba
Stefano
S
Chair of Obstetrics and Gynecology, University of Catanzaro, Catanzaro, Italy. stefanopalomba@tin.it
Morelli
Michele
M
Di Carlo
Costantino
C
Noia
Roberto
R
Pellicano
Massimiliano
M
Zullo
Fulvio
F
D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage* / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D001846:Bone Development / Q000187:drug effects; D001842:Bone and Bones / Q000378:metabolism*; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D007889:Leiomyoma / Q000188:drug therapy* / Q000601:surgery; D016729:Leuprolide / Q000008:administration & dosage* / Q000009:adverse effects; D008159:Lumbar Vertebrae / Q000187:drug effects; D008875:Middle Aged; D009652:Norpregnenes / Q000008:administration & dosage* / Q000009:adverse effects; D015663:Osteoporosis, Postmenopausal / Q000517:prevention & control; D010052:Ovariectomy / Q000009:adverse effects; D017698:Postmenopause / Q000378:metabolism*; D011446:Prospective Studies; D012016:Reference Values; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000601:surgery
D018931:Antineoplastic Agents, Hormonal; D009652:Norpregnenes; D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide; C027385:tibolone