We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Prevention of estrogen deficiency-related bone loss with human parathyroid hormone-(1-34): a randomized controlled trial.
- Authors
Finkelstein JS; Klibanski A; Arnold AL; Toth TL; Hornstein MD; Neer RM; Finkelstein, J S; Klibanski, A; Arnold, A L; Toth, T L; Hornstein, M D; Neer, R M
- Abstract
<bold>Context: </bold>Short-term intermittent administration of parathyroid hormone (PTH) prevents bone loss from the spine in women treated with a gonadotropin-releasing hormone (GnRH) analog. However, the effects of a longer period of PTH administration on bone mass in estrogen-deficient women, particularly on the hip and on cortical bone of the total body, are unknown.<bold>Objective: </bold>To determine whether more prolonged PTH administration can prevent estrogen deficiency bone loss from the hip, spine, and total body in young women with endometriosis receiving GnRH analog (nafarelin acetate) therapy.<bold>Design: </bold>Randomized controlled trial.<bold>Setting: </bold>General Clinical Research Center of a tertiary care, university-affiliated hospital.<bold>Patients: </bold>Forty-three women between the ages of 21 and 45 years with symptomatic endometriosis.<bold>Intervention: </bold>Nafarelin alone (200 microg intranasally twice daily) or nafarelin plus human parathyroid hormone-(1-34) (hPTH-[1-34]) (40 microg subcutaneously daily).<bold>Main Outcome Measures: </bold>The primary end points were bone mineral density (BMD) of the anterior-posterior and lateral spine, femoral neck, trochanter, radial shaft, and total body at 12 months of treatment.<bold>Results: </bold>In the women who received nafarelin alone, the mean (SEM) BMDs of the anterior-posterior spine, lateral spine, femoral neck, trochanter, and total body were 4.9% (0.6%) (P<.001), 4.9% (0.8%) (P<.001), 4.7% (1.1%) (P<.001), 4.3% (0.9%) (P<.001), and 2.0% (0.6%) (P= .003) lower than at baseline after 12 months of therapy. In contrast, coadministration of hPTH-(1-34) increased BMD of the anterior-posterior spine by 2.1% (1.1%) (P=.09) and lateral spine by 7.5% (1.9%) (P=.002) and prevented bone loss from the femoral neck, trochanter, and total body, despite severe estrogen deficiency. Radial shaft BMD did not change significantly in either group. Serum bone-specific alkaline phosphatase and osteocalcin concentrations and urinary excretion of hydroxyproline and deoxypyridinoline increased 2-fold to 3-fold during the first 6 to 9 months of therapy in the women who received nafarelin plus hPTH-(1-34) and then declined. Changes in urinary deoxypyridinolone excretion were strongly predictive (r= 0.85) of changes in spinal BMD in the women who received nafarelin plus hPTH-(1-34).<bold>Conclusions: </bold>Parathyroid hormone prevents bone loss from the proximal femur and total body and increases lumbar spinal BMD in young women with GnRH analog-induced estrogen deficiency.
- Publication
JAMA: Journal of the American Medical Association, 1998, Vol 280, Issue 12, p1067
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.280.12.1067