Effects on bone mineral density of 12-month goserelin treatment in over 40-year-old women with uterine myomas

Abstract

We evaluated the effects on bone mineral density (BMD) of a 12-month treatment with goserelin depot, a gonadotropin-releasing hormone agonist, in a group of women with symptomatic uterine myomas requiring hysterectomy. Sixteen women, mean age 45.6±5.0, reporting menorrhagia associated with uterine myomas, candidates for hysterectomy, were scheduled to be treated with goserelin depot for 12 months. BMD was measured at the vertebral (L2–L4) and proximal femur level (femoral neck and trochanter) at the start of therapy and 6, 12, and 18 months later using dual energy X-ray absorptiometry (Hologic QDR 1000/W). The patients were followed for a minimum of 6 months after the end of treatment. Thirteen of the 16 women enrolled completed the treatment and three suspended it after 5, 6, and 7 months, respectively, because of side effects (hot flashes, insomnia, depression). Of the 13 women who completed the treatment, three underwent hysterectomy because of myoma regrowth and the recurrence of symptoms 3–18 months later; four reached the menopause 5–16 months later, and six were all menstruating normally with a follow-up varying from 6 to 18 months. After 12 months of therapy we observed a bone loss at vertebral, femoral neck, and trochanter of 4.4% (P<0.05 versus baseline; P = not significant versus 6 months), 7.5% (P<0.01 versus baseline, P<0.01 versus 6 months), and 7.6% (P<0.001 versus baseline, P<0.05 versus 6 months), respectively. Six months later, BMD increased slightly and not significantly at different sites (0.9% at the spine, and 0.3% at femoral neck, and 1.1% at trochanter). A 12-month treatment with goserelin may avoid the need for hysterectomy in women over 40 with symptomatic myomas. However, this therapy is associated with a marked bone loss which is not significantly reversed at its suspension.