leuprolide and Osteoporosis--Postmenopausal

To study the bone metabolism in postmenopausal women who have been treated with gonadotropin-releasing hormone agonist (GnRH-a) and tibolone.. Prospective, open, controlled clinical trial.. Department of Gynecology and Obstetrics, University of Catanzaro, Catanzaro, Italy.. 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).. Treatment for 12 months with leuprolide acetate plus tibolone (group A) or hysterectomy with bilateral oophorectomy (group B).. 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).. 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.. 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.

Topics: Antineoplastic Agents, Hormonal; Antineoplastic Combined Chemotherapy Protocols; Bone and Bones; Bone Density; Bone Development; Female; Gonadotropin-Releasing Hormone; Humans; Hysterectomy; Leiomyoma; Leuprolide; Lumbar Vertebrae; Middle Aged; Norpregnenes; Osteoporosis, Postmenopausal; Ovariectomy; Postmenopause; Prospective Studies; Reference Values; Uterine Neoplasms

In a double-blind, placebo controlled study, ipriflavone (600 mg/day, T.D.D.) or identical placebo tablets were given with 500 mg/day of calcium to patients treated with the gonadotropin hormone-releasing hormone agonist (Gn-RH-A) leuproreline acetate, 3.75 mg every 30 days for 6 months. In placebo-treated subjects (n = 39), urinary hydroxyproline excretion and plasma osteocalcin levels showed a significant (P < 0.01 and P < 0.05, respectively) increase, whereas spine bone density and total body bone density significantly (P < 0.001 and P < 0.05, respectively) decreased after 3 and 6 months of GnRH-A administration. Conversely, in the ipriflavone-treated group (n = 39), no significant difference in bone markers and bone density was evidenced. These data indicate that ipriflavone can restrain the bone remodeling processes and prevent the rapid bone loss that follows medically induced hypogonadism.

Topics: Absorptiometry, Photon; Analysis of Variance; Antineoplastic Agents, Hormonal; Bone Density; Bone Remodeling; Female; Follow-Up Studies; Gonadotropin-Releasing Hormone; Humans; Hypogonadism; Isoflavones; Leiomyoma; Leuprolide; Lumbar Vertebrae; Menopause; Metrorrhagia; Osteoporosis, Postmenopausal; Treatment Outcome; Uterine Neoplasms; Uterus

If indeed younger women do not receive bone protection from standard postmenopausal hormone replacement, these women may also be at increased risk for heart disease, urogenital atrophy, and other effects of long-term hypoestrogenism with 0.625 mg of CE add-back. We recommend that until long-term studies using BMD of the lumbar spine are available, 1.25 mg of CE or the equivalent dosage of other Es be prescribed when planning long-term GnRH-a ovarian suppression.

Topics: Absorptiometry, Photon; Adult; Bone Density; Estrogen Replacement Therapy; Estrogens, Conjugated (USP); Female; Femur Neck; Humans; Leuprolide; Lumbosacral Region; Menopause; Osteoporosis, Postmenopausal; Spine; Time Factors