MEDROXYPROGESTERONE ACETATE WITH ZOLADEX(TM) FOR LONG-TERM TREATMENT OF FIBROIDS - EFFECTS ON BONE-DENSITY AND PATIENT ACCEPTABILITY

A randomized trial was carried out to investigate the effect of 12 mon ths administration of the gonadotrophin-releasing hormone agonist (GnR Ha) Zoladex(TM) in combination with either placebo or medroxyprogester one acetate (MPA) from the third month, Bone density, markers of bone resorption, symptoms and uterine volume were, monitored in 24 women wi th symptomatic fibroids or menstrual problems, A total of 21 women wer e recruited to act as controls for the assessment of bone parameters, Vasomotor side-effects mere reduced significantly in the MPA-treated g roup, The reduction in uterine volume in women with fibroids was not i mpaired by the addition of MPA, The bone markers osteocalcin and alkal ine phosphatase were assessed in plasma, and the cross-links pyridinol ine and deoxypyridinoline measured in urine, Changes in these markers are reported which suggest increases in bone resorption during the per iod of observation, Bone mineral density (BMD) mas assessed by dual en ergy X-ray absorptiometry at the spine and forearm, The net reduction in BMD at the spine in the treated groups was 4.30 +/- 0,59% at 6 mont hs and 7.50 +/- 0,75% at 1 year, with no change in the control group, No change was seen in forearm BMD. No protective effect was observed w hen MPA was added, At 1 year after the completion of treatment, BMD re mained significantly below baseline, and this has implications for the prolonged use of GnRHa.