Impacto do uso de análogos de GnRH sobre o tecido e metabolismo ósseo de pacientes endometríoticas

Abstract

This research had as an objective of evaluate endometriotic women treated with GnRH analogues by investigating their bone turnover and bone structure using serum bone turnover markers and calcaneous ultrasonometry, respectively. This is a transversal, observational, prospective case–control study. It was developed at Maternidade-Escola Assis Chateaubriand (MEAC) – UFC. Ninety nine women, divided into three groups were analyzed. Thirty two endometriotic women were treated with goserelin 3,6mg SC 28/28d (4 doses) – Endometriotic group. Their disease had been confirmed by surgery. The second group had twenty five non endometriotic women and having menses (control group). The third group had 42 not endometriotic menopausal women, they were at menopause at least for 2 years. The latest two groups were not taking any treatment. The Achilles device from Lunar, had being used to analyse the bone structure through calcaneous ultrasonometry. We calculated the “stiffness” value for each group (a combination of sound velocity and ultrasonographic attenuation), and we also analysed the values of magnesium, phosphate, urea, creatinine, serum calcium, alkaline phosphatase (ALP), parathyroid hormone (PTH), cortisol, hydroxyproline, urinary calcium, urinary calcium/creatinine, and hydroxyproline/creatinine. The endometriotic group was evaluated only after the treatment. The statistical analysis had being done by SPSS program for Windows version 11.0.0. The values of ALP, urinary calcium and urinary calcium/creatinine were similar to endometriotic group (40.8±7.7U/mL; 47.15±10.8mmol/L; and 78.76±23.0, respectively) and to menopausal group (38.65±5.1U/mL; 36.8±4.3mmol/L; and 55.21±8.21, respectively) although significantly higher than control group (28.5±2.54U/mL; 26.4±3.4mmol/L; and 39.52±7.7, respectively). The values of PTH from endometriotic group (23.99±3.35nmol/L) were similar to control group (29.15±4.09nmol/L), and both were significantly lower than menopausal one (41.14±3.7nmol/L). The other values were equal between groups. At the evaluation of bone “stiffness” the values were similar between endometriotic (88.16±2.86) and menopausal groups (83.70±1.8), and both were significantly lower than control group (97.02±1.46). Concluding the endometriotic women who received treatment with goserelin showed an intense bone metabolism and a bone deficit at calcaneous ultrasonometry almost like women at post-menopausal at least two years. Therefore, we can not affirm if these alterations were caused exclusively by the GnRH-analogue therapy or were influenciated by endometriosis itself. We suggest that endometriosis and treatment with GnRH analogues might be considered as risks factors for the development of osteoporosis, principally if they are associated with chronic corticoid treatment at any point in a lifetime.