This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Finkelstein, J. S. Articles by Arnold, A. L. Search for Related Content PubMed PubMed Citation Articles by Finkelstein, J. S. Articles by Arnold, A. L.

Increases in Bone Mineral Density after Discontinuation of Daily Human Parathyroid Hormone and Gonadotropin-Releasing Hormone Analog Administration in Women with Endometriosis¹

Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114

Address all correspondence and requests for reprints to: Joel S. Finkelstein, M.D., Endocrine Unit, Bulfinch 327, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114. E-mail: finkelstein{at}helix.mgh.harvard.edu

Intermittent PTH administration increases spinal bone mineral density (BMD) and prevents bone loss from the hip and total body in young women treated with a long acting GnRH analog for endometriosis. To establish whether these beneficial effects on BMD persist after PTH administration is discontinued, we remeasured BMD and biochemical markers of bone turnover in 38 women with endometriosis who had been treated with a GnRH analog alone (nafarelin acetate; 200 µg, intranasally, twice daily; n = 23; group 1) or who had received nafarelin plus human PTH-(1–34) (40 µg/day, sc; n = 15; group 2) for 6–12 months 1 yr after therapy was completed. Cyclic menstrual function returned promptly after nafarelin therapy was discontinued. In group 1, BMD increased significantly at all sites [P < 0.001 for the anterior-posterior (AP) and lateral spine; P = 0.014 for the femoral neck; P = 0.004 for the trochanter], except the proximal radius (P = 0.065) and total body bone density (P = 0.069) after nafarelin therapy was stopped. In group 2, BMD increased significantly at the AP spine (P < 0.001), lateral spine (P = 0.012), femoral neck (P = 0.002), and trochanter (P = 0.029) after nafarelin therapy was stopped. BMD of the spine in the AP projection increased more in group 2 and than in group 1 after therapy was stopped (P = 0.045). Despite these increases after discontinuation of nafarelin therapy, BMD was still significantly below baseline values at the AP spine (P < 0.001) and femoral neck (P = 0.006) and tended to be lower than baseline values at the trochanter (P = 0.057) and total body (P = 0.101) at the end of the 1-yr follow-up period in group 1. In contrast, BMD was significantly above baseline values at the AP and lateral spine (P < 0.001) sites and was similar to baseline values at the other skeletal sites at the end of the 1-yr follow-up period in group 2. Bone turnover returned to baseline values in both groups when therapy was stopped. We conclude that the beneficial effects of PTH on bone persist in women who regain cyclic menstrual function. Although part of the increases in BMD are probably due to restoration of ovarian function, additional increases in BMD most likely represent a further anabolic effect of PTH on bone that is not detected until after PTH administration is stopped.

This article has been cited by other articles:

				J. S. Finkelstein, J. J. Wyland, B. Z. Leder, S.-A. M. Burnett-Bowie, H. Lee, H. Juppner, and R. M. Neer Effects of Teriparatide Retreatment in Osteoporotic Men and Women J. Clin. Endocrinol. Metab., July 1, 2009; 94(7): 2495 - 2501. [Abstract] [Full Text] [PDF]

				S. Palomba, F. Orio Jr., M. Morelli, T. Russo, M. Pellicano, C. Nappi, P. Mastrantonio, G. Lombardi, A. Colao, and F. Zullo Raloxifene Administration in Women Treated with Gonadotropin-Releasing Hormone Agonist for Uterine Leiomyomas: Effects on Bone Metabolism J. Clin. Endocrinol. Metab., October 1, 2002; 87(10): 4476 - 4481. [Abstract] [Full Text] [PDF]

				C. J. Rosen and J. P. Bilezikian Anabolic Therapy for Osteoporosis J. Clin. Endocrinol. Metab., March 1, 2001; 86(3): 957 - 964. [Abstract] [Full Text]

				B. M. K. Biller, G. Sesmilo, H. B. A. Baum, D. Hayden, D. Schoenfeld, and A. Klibanski Withdrawal of Long-Term Physiological Growth Hormone (GH) Administration: Differential Effects on Bone Density and Body Composition in Men with Adult-Onset GH Deficiency J. Clin. Endocrinol. Metab., March 1, 2000; 85(3): 970 - 976. [Abstract] [Full Text]