Efficacy of Add-back Therapy with Tibolone for Prevention of Bone Mineral Density Loss in Women Treated with GnRH Agonist for Endometriosis
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Objectives: To determine the effect of tibolone add- back therapy for prevention of bone mineral density loss in women treated with GnRH agonist for their endometriosis. Methods: Medical records of 179patients who had been given a laparoscopically or pathologically proven diagnosis of endometriosis and finished the 6cycles of goserelin acetate 3.78mg treatment were reviewed retrospectively. Twenty five patients were excluded because either or both pre-and post-treatment bone mineral density(BDM) examination was not carried out. The BMD of the lumbar spine(L1-L4) and femur neck was measured by dual energy X-ray absorptiometry two times(Pre- and post-GnRH agonist treatment). Tibolone add-back therapy was given to 97patients and remaining 57patients were not received. Results: The mean age was 40.61±6.89years and mean body mass index was 23.43±3.14(kg/㎠). Comparing to pretreatment value, the mean decrease of BMD of lumbar spine and femur neck in without add-back group and with add-back group was 0.060±0.024 and 0.047±0.022, respectively. The mean decrease of BMD of lumbar spine was prevented significantly in add-back group(P=0.044). Conclusions: Tibolone add-back therapy could prevent BMD loss occurs during 6 cycles of GnRH agonist treatment especially in lumbar spine.
Abstract
Objectives: To determine the effect of tibolone add- back therapy for prevention of bone mineral density loss in women treated with GnRH agonist for their endometriosis. Methods: Medical records of 179patients who had been given a laparoscopically or pathologically proven diagnosis of endometriosis and finished the 6cycles of goserelin acetate 3.78mg treatment were reviewed retrospectively. Twenty five patients were excluded because either or both pre-and post-treatment bone mineral density(BDM) examination was not carried out. The BMD of the lumbar spine(L1-L4) and femur neck was measured by dual energy X-ray absorptiometry two times(Pre- and post-GnRH agonist treatment). Tibolone add-back therapy was given to 97patients and remaining 57patients were not received. Results: The mean age was 40.61±6.89years and mean body mass index was 23.43±3.14(kg/㎠). Comparing to pretreatment value, the mean decrease of BMD of lumbar spine and femur neck in without add-back group and with add-back group was 0.060±0.024 and 0.047±0.022, respectively. The mean decrease of BMD of lumbar spine was prevented significantly in add-back group(P=0.044). Conclusions: Tibolone add-back therapy could prevent BMD loss occurs during 6 cycles of GnRH agonist treatment especially in lumbar spine.
참고문헌 (29)
- Giudice LC, "Endometriosis", Lancet, 364, pp.1789~1799 (2004)
- Olive DL, "Optimizing gonadotropin-releasing hormone agonist therapy in women with endometriosis", Treat Endocrinol, 3, pp.83~89 (2004)
- Hornstein MD, "Leuprolide acetate depot and hormonal addback in endometriosis: a 12-month study", Obstet Gynecol, 91, pp.16~24 (1998), Lupron Add-Back Study Group
- Orwoll ES, "Nafarelin therapy in endometriosis: long-term effects on bone mineral density", Am J Obstet Gynecol, 171, pp.1221~1225 (1994)
- Matsuo H, "Bone loss induced by GnRHa treatment in women", Nippon Rinsho, 61, pp.314~318 (2003)
- Mitwally MF, "Prevention ofbone loss and hypoestrogenic symptoms by estrogen and interrupted progestogen add-back in long-term GnRH-agonist down-regulated patients with endometriosis and premenstrual syndrome", Menopause, 9, pp.236~241 (2002)
- Riggs BL, "Tibolone as an alternative to estrogen for the prevention of postmenopausal osteoporosis in selected postmenopausal women", J Clin Endocrinol Metab, 81, pp.2417~2418 (1996)
- Uryan II, "Effectiveness and Long-Term Safety of Prolonged Gosereline and Tibolone in Women with Endometriosis", J Am Assoc Gynecol Laparosc, 3, pp.S51~S52 (1996)
- Edmonds DK, "Add-back therapy in the treatment of endometriosis: the European experience", Br J Obstet Gynaecol, 103(14), pp.10~13 (1996)
- Bedaiwy MA, "Treatment with leuprolide acetate and hormonal add-back for up to 10 years in stage IV endometriosis patients with chronic pelvic pain", Fertil Steril, 86, pp.220~222 (2006)
- Cheung TH, "Dose effects of progesterone in add-back therapy during GnRHa treatment", J Reprod Med, 50, pp.35~40 (2005)
- Olive DL, "Treatment of endometriosis", N Engl J Med, 345, pp.266~275 (2001)
- Gargiulo AR, "The role of GnRH agonists plus add-back therapy in the treatment of endometriosis", Semin Reprod Endocrinol, 15, pp.273~284 (1997)
- Friedman AJ, "A randomized, double-blind trial of a gonadotropin releasing-hormone agonist (leuprolide) with or without medroxyprogesterone acetate in the treatment of leiomyomata uteri", Fertil Steril, 49, pp.404~409 (1988)
- Barbieri RL, "Hormone treatment of endometriosis: the estrogen threshold hypothesis", Am J Obstet Gynecol, 166, pp.740~745 (1992)
- Compston JE, "The effects of gonadotrophin-releasing hormone agonists on iliac crest cancellous bone structure in women with endometriosis", Bone, 16, pp.261~267 (1995)
- Yu Q, "Clinical manifestations of low bone mass in amenorrhea patients with elevated follicular stimulating hormone", Chin Med J (Engl), 115, pp.1376~1379 (2002)
- Paoletti AM, "Spontaneous reversibility of bone loss induced by gonadotropinreleasing hormone analog treatment", Fertil Steril, 65, pp.707~710 (1996)
- Pickersgill A, "GnRH agonists and add-back therapy: is there a perfect combination?", Br J Obstet Gynaecol, 105, pp.475~485 (1998)
- Taskin O, "Effectiveness of tibolone on hypoestrogenic symptoms induced by goserelin treatment in patients with endometriosis", Fertil Steril, 67, pp.40~45 (1997)
- Franke HR, "Gonadotropin-releasing hormone agonist plus “add-back” hormone replacement therapy for treatment of endometriosis: a prospective, randomized, placebo-controlled, double-blind trial", Fertil Steril, 74, pp.534~539 (2000)
- Lindsay R, "Prospective double-blind trial of synthetic steroid (Org OD 14) for preventing postmenopausal osteoporosis", Br Med J, 280, pp.1207~1209 (1980)
- Nathorst-Boos J, "Effect on sexual life-a comparison between tibolone and a continuous estradiol-norethisterone acetate regimen", Maturitas, 26, pp.15~20 (1997)
- Vanin CM, "The effect of three hormone replacement regimens on bone density in the aged ovariectomized rat", Fertil Steril, 63, pp.643~651 (1995)
- Moghissi KS, "Goserelin acetate (Zoladex) with or without hormone replacement therapy for the treatment of endometriosis", Fertil Steril, 69, pp.1056~1062 (1998)
- Gnoth CH, "Effects of add-back therapy on bone mineral density and pyridinium crosslinks in patients with endometriosis treated with gonadotropinreleasing hormone agonists", Gynecol Obstet Invest, 47, pp.37~41 (1999)
- Nencioni T, "Gonadotropin releasing hormone agonist therapy and its effect on bone mass", Gynecol Endocrinol, 5, pp.49~56 (1991)
- Pierce SJ, "Longterm use of gonadotropin-releasing hormone analogs and hormone replacement therapy in the management of endometriosis: a randomized trial with a 6-year follow-up", Fertil Steril, 74, pp.964~968 (2000)
- Lindsay PC, "The effect of add-back treatment with tibolone (Livial) on patients treated with the gonadotropinreleasing hormone agonist triptorelin (Decapeptyl)", Fertil Steril, 65, pp.342~348 (1996)