Title:The Skeletal Effects of Gonadotropin-Releasing Hormone Antagonists: A Concise Review
Volume: 21
Issue: 10
Author(s): Nur-Vaizura Mohamad, Soelaiman Ima-Nirwana and Kok-Yong Chin*
Affiliation:
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur,Malaysia
Keywords:
Bone mineral density, estrogen, fracture, osteoporosis, sex hormones, testosterone.
Abstract: Prolonged treatment with Gonadotropin-Releasing Hormone (GnRH) agonists is known
to induce bone loss among prostate cancer patients. However, evidence on the skeletal effects of
GnRH antagonists is relatively less well-known. This review aims to examine the effects of GnRH
antagonists on bone health. GnRH antagonists are an effective treatment for hormone-dependent
conditions, such as advanced prostate cancer and endometriosis. They induce a competitive and reversible
GnRH-receptor blockage, thereby suppressing the release of gonadotropins and sex hormones.
The sex hormone ablation results in undesirable side effects, including accelerated bone
loss. In animal studies, treatment with GnRH antagonists is reported to cause deterioration of bone
microstructure. Human clinical trials revealed significant bone loss at the spine, hip and femur in
patients treated with GnRH antagonists. Thus, osteoporosis and the resultant fragility fractures
pose a significant impact on health and quality of life of GnRH antagonist users. Thus, early preventive
measures of bone loss are critical in preventing fractures and its associated morbidity in these
patients.
