The effects of danazol or buserelin treatment on the bone mineral density and calcium metabolism in patients with endometriosis.
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The decrease of serum estrogen level after menopause or oophorectomy is the one of the most important factors in the etiology of osteoporosis. Since marked decrease in serum estrogen is also observed during treatment of endometriosis with danazol or buserelin, this hypoestrogenic state may also induce loss of bone mineral density (BMD).<BR>The purpose of this study was to investigate the effects of danazol on the calcium metabolism of patients with endometriosis. Danazol (400mg/day) was administered orally to 5 patients and buserelin (900μg/day) nasally to 13 patients for 6 months.The BMD of the lumbar spine (L3) measured by quantitative computed tomography (QCT) at the end of buserelin treatment was decreased by 13.7% compared to the initial value, and six months after the end of treatment it still remained lower than that before treatment. Serum estradiol level was markedly suppressed and serum concentrations of Ca, Pi, ALP and osteocalcin were elevated during buserelin treatment, but showed normal values 6 months after the end of treatment.Serum intact PTH level during and 6 months after the end of treatment was significantly decreased compared to the initial value. These results suggest that bone metabolism in patients who have received buserelin treatment is of the high turnover type I described by Riggs et al., which is observed in the osteoporosis in early climacteric. The rate of bone loss during and after the buserelin treatment was decreased by simultaneous administration of ipriflavone and la (OH) vitamin D3.<BR>On the other hand, no significant change in BMD was observed either during or after the treatment in the danazol group. Serum estradiol level was decreased, but not significantly, and higher than that observed during buserelin treatment. There were no significant changes in the concentrations of minerals and hormones associated with calcium metabolism. The reason for the absence of decrease in BMD in the women treated with danazol is unknown. However, the reduction of estrogen level was less marked in these patients than in the patients treated with buserelin, and we speculate that danazol might have anabolic effects or acts directly on bone metabolism, which may prevent severe decrease of BMD.
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