Divasta Amy D, Laufer Marc R, Gordon Catherine M
Division of Adolescent Medicine, Children's Hospital Boston, MA 02115, USA.
J Pediatr Adolesc Gynecol. 2007 Oct;20(5):293-7. doi: 10.1016/j.jpag.2007.04.008.
To evaluate the bone density of adolescents with endometriosis treated with a GnRH-agonist and "add-back" therapy with norethindrone acetate.
Retrospective chart review.
Pediatric gynecology clinic at a tertiary care center.
36 adolescents, ages 13 to 21 years, with endometriosis.
Bone mineral density (BMD, g/cm(2)) by dual energy x-ray absorptiometry (DXA); BMD Z-scores of hip and spine.
The mean BMD Z-score at the total hip was -0.24 +/- 1.0, with a range of -2.4 to 1.7. At this site, 6 subjects had a BMD Z-score between -1.0 and -2.0 SD, while 2 had a Z-score < or = -2.0 SD. The mean BMD Z-score at the lumbar spine was 0.55 +/- 1.1, with a range of -2.8 to 1.4. At the spine, 11 subjects had a BMD Z-score between -1.0 and -2.0 SD, while 3 had a Z-score < or = -2.0 SD. There was no correlation noted between duration of therapy with the GnRH-agonist plus add-back and BMD at the hip or spine.
BMD at the hip was normal in most adolescents with endometriosis who were receiving a GnRH-agonist plus add-back therapy with norethindrone acetate. Almost one third of subjects exhibited skeletal deficits at the spine. These data suggest that BMD should be carefully monitored in adolescents receiving treatment with GnRH agonists.
评估接受促性腺激素释放激素（GnRH）激动剂及醋酸炔诺酮“反向添加”疗法治疗的子宫内膜异位症青少年的骨密度。
回顾性病历审查。
三级医疗中心的儿科妇科诊所。
36名年龄在13至21岁之间的患有子宫内膜异位症的青少年。
采用双能X线吸收法（DXA）测量骨矿物质密度（BMD，g/cm²）；髋部和脊柱的BMD Z值。
全髋部的平均BMD Z值为-0.24±1.0，范围为-2.4至1.7。在该部位，6名受试者的BMD Z值在-1.0至-2.0标准差之间，而2名受试者的Z值≤-2.0标准差。腰椎的平均BMD Z值为0.55±1.1，范围为-2.8至1.4。在脊柱部位，11名受试者的BMD Z值在-1.0至-2.0标准差之间，而3名受试者的Z值≤-2.0标准差。未发现GnRH激动剂加反向添加疗法的治疗持续时间与髋部或脊柱的BMD之间存在相关性。
大多数接受GnRH激动剂加醋酸炔诺酮反向添加疗法治疗的子宫内膜异位症青少年的髋部骨密度正常。近三分之一的受试者脊柱出现骨骼缺陷。这些数据表明，接受GnRH激动剂治疗的青少年应仔细监测骨密度。
