Effect of gonadotropin-releasing hormone agonist and medroxyprogesterone acetate on calcium metabolism

A prospective, randomized, double-blind, placebo-controlled, crossover trial

Bruce R. Carr, Neil A. Breslau, Noel Peng, Beverley Adams-Huet, Karen D. Bradshaw, Michael P. Steinkampf

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective: The purpose of this study was to prospectively compare the effectiveness of administering medroxyprogesterone acetate (MPA; 20 mg/d) in either the first (protocol A) or last (protocol B) 12-week period as well as a 6-month course of the GnRH agonist (GnRH-a; leuprolide acetate; 1 mg/d, SC) on calcium (Ca) metabolism. Design: Prospective, randomized, double-blind, placebo-controlled, crossover trial. Setting: Clinical research center, university hospital. Patient(s): Twenty women were randomized into protocol A or B, received either MPA or placebo along with GnRH-a, and were then crossed over at 12 weeks to placebo or MPA, for the final 12-week interval of GnRH-a therapy. Intervention(s): Collection of serum and urine samples and measurement of bone density. Main Outcome Measure(s): Sex hormone, calcitropic hormone, and bone density studies were performed at baseline and at 12 and 24 weeks. Result(s): In both protocol A and B, LH and E2 levels declined by 79%-81% and 83%-90% of the baseline, respectively, at 12 and 24 weeks. Serum Ca, phosphorus, alkaline phosphatase, and osteocalcin; 2-h fasting and 24-h urinary Ca excretion; and urinary hydroxyproline levels all increased significantly during GnRH-a treatment alone. Estimated Ca balance decreased significantly during GnRH-a treatment alone. The addition of MPA attenuated the increases in phosphorus, alkaline phosphatase, osteocalcin, and 2-h fasting and 24-h urinary Ca excretion, and the decrease in estimated Ca balance. Comparison of phase order demonstrated that MPA prevented 24-h urinary Ca excretion and urinary hydroxyproline loss and decline in estimated Ca balance when it was added back during the second 12 weeks (protocol B) but not during the first 12 weeks (protocol A). Conclusion(s): We conclude that sequential MPA appears to reverse in part the negative effects of GnRH-a on calcitropic hormones and estimated Ca balance.

Original languageEnglish (US)
Pages (from-to)1216-1223
Number of pages8
JournalFertility and Sterility
Volume80
Issue number5
DOIs
StatePublished - Nov 2003

Fingerprint

Medroxyprogesterone Acetate
Gonadotropin-Releasing Hormone
Cross-Over Studies
Placebos
Calcium
Hydroxyproline
Osteocalcin
Bone Density
Phosphorus
Alkaline Phosphatase
Fasting
Hormones
Leuprolide
Urine Specimen Collection
Gonadal Steroid Hormones
Serum
Therapeutics
Outcome Assessment (Health Care)

Keywords

  • Calcium
  • Gonadotropin-releasing hormone agonist
  • Medroxyprogesterone acetate

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

@article{3384903fff694993bdf8854bfbc38914,
title = "Effect of gonadotropin-releasing hormone agonist and medroxyprogesterone acetate on calcium metabolism: A prospective, randomized, double-blind, placebo-controlled, crossover trial",
abstract = "Objective: The purpose of this study was to prospectively compare the effectiveness of administering medroxyprogesterone acetate (MPA; 20 mg/d) in either the first (protocol A) or last (protocol B) 12-week period as well as a 6-month course of the GnRH agonist (GnRH-a; leuprolide acetate; 1 mg/d, SC) on calcium (Ca) metabolism. Design: Prospective, randomized, double-blind, placebo-controlled, crossover trial. Setting: Clinical research center, university hospital. Patient(s): Twenty women were randomized into protocol A or B, received either MPA or placebo along with GnRH-a, and were then crossed over at 12 weeks to placebo or MPA, for the final 12-week interval of GnRH-a therapy. Intervention(s): Collection of serum and urine samples and measurement of bone density. Main Outcome Measure(s): Sex hormone, calcitropic hormone, and bone density studies were performed at baseline and at 12 and 24 weeks. Result(s): In both protocol A and B, LH and E2 levels declined by 79{\%}-81{\%} and 83{\%}-90{\%} of the baseline, respectively, at 12 and 24 weeks. Serum Ca, phosphorus, alkaline phosphatase, and osteocalcin; 2-h fasting and 24-h urinary Ca excretion; and urinary hydroxyproline levels all increased significantly during GnRH-a treatment alone. Estimated Ca balance decreased significantly during GnRH-a treatment alone. The addition of MPA attenuated the increases in phosphorus, alkaline phosphatase, osteocalcin, and 2-h fasting and 24-h urinary Ca excretion, and the decrease in estimated Ca balance. Comparison of phase order demonstrated that MPA prevented 24-h urinary Ca excretion and urinary hydroxyproline loss and decline in estimated Ca balance when it was added back during the second 12 weeks (protocol B) but not during the first 12 weeks (protocol A). Conclusion(s): We conclude that sequential MPA appears to reverse in part the negative effects of GnRH-a on calcitropic hormones and estimated Ca balance.",
keywords = "Calcium, Gonadotropin-releasing hormone agonist, Medroxyprogesterone acetate",
author = "Carr, {Bruce R.} and Breslau, {Neil A.} and Noel Peng and Beverley Adams-Huet and Bradshaw, {Karen D.} and Steinkampf, {Michael P.}",
year = "2003",
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T1 - Effect of gonadotropin-releasing hormone agonist and medroxyprogesterone acetate on calcium metabolism

T2 - A prospective, randomized, double-blind, placebo-controlled, crossover trial

AU - Carr, Bruce R.

AU - Breslau, Neil A.

AU - Peng, Noel

AU - Adams-Huet, Beverley

AU - Bradshaw, Karen D.

AU - Steinkampf, Michael P.

PY - 2003/11

Y1 - 2003/11

N2 - Objective: The purpose of this study was to prospectively compare the effectiveness of administering medroxyprogesterone acetate (MPA; 20 mg/d) in either the first (protocol A) or last (protocol B) 12-week period as well as a 6-month course of the GnRH agonist (GnRH-a; leuprolide acetate; 1 mg/d, SC) on calcium (Ca) metabolism. Design: Prospective, randomized, double-blind, placebo-controlled, crossover trial. Setting: Clinical research center, university hospital. Patient(s): Twenty women were randomized into protocol A or B, received either MPA or placebo along with GnRH-a, and were then crossed over at 12 weeks to placebo or MPA, for the final 12-week interval of GnRH-a therapy. Intervention(s): Collection of serum and urine samples and measurement of bone density. Main Outcome Measure(s): Sex hormone, calcitropic hormone, and bone density studies were performed at baseline and at 12 and 24 weeks. Result(s): In both protocol A and B, LH and E2 levels declined by 79%-81% and 83%-90% of the baseline, respectively, at 12 and 24 weeks. Serum Ca, phosphorus, alkaline phosphatase, and osteocalcin; 2-h fasting and 24-h urinary Ca excretion; and urinary hydroxyproline levels all increased significantly during GnRH-a treatment alone. Estimated Ca balance decreased significantly during GnRH-a treatment alone. The addition of MPA attenuated the increases in phosphorus, alkaline phosphatase, osteocalcin, and 2-h fasting and 24-h urinary Ca excretion, and the decrease in estimated Ca balance. Comparison of phase order demonstrated that MPA prevented 24-h urinary Ca excretion and urinary hydroxyproline loss and decline in estimated Ca balance when it was added back during the second 12 weeks (protocol B) but not during the first 12 weeks (protocol A). Conclusion(s): We conclude that sequential MPA appears to reverse in part the negative effects of GnRH-a on calcitropic hormones and estimated Ca balance.

AB - Objective: The purpose of this study was to prospectively compare the effectiveness of administering medroxyprogesterone acetate (MPA; 20 mg/d) in either the first (protocol A) or last (protocol B) 12-week period as well as a 6-month course of the GnRH agonist (GnRH-a; leuprolide acetate; 1 mg/d, SC) on calcium (Ca) metabolism. Design: Prospective, randomized, double-blind, placebo-controlled, crossover trial. Setting: Clinical research center, university hospital. Patient(s): Twenty women were randomized into protocol A or B, received either MPA or placebo along with GnRH-a, and were then crossed over at 12 weeks to placebo or MPA, for the final 12-week interval of GnRH-a therapy. Intervention(s): Collection of serum and urine samples and measurement of bone density. Main Outcome Measure(s): Sex hormone, calcitropic hormone, and bone density studies were performed at baseline and at 12 and 24 weeks. Result(s): In both protocol A and B, LH and E2 levels declined by 79%-81% and 83%-90% of the baseline, respectively, at 12 and 24 weeks. Serum Ca, phosphorus, alkaline phosphatase, and osteocalcin; 2-h fasting and 24-h urinary Ca excretion; and urinary hydroxyproline levels all increased significantly during GnRH-a treatment alone. Estimated Ca balance decreased significantly during GnRH-a treatment alone. The addition of MPA attenuated the increases in phosphorus, alkaline phosphatase, osteocalcin, and 2-h fasting and 24-h urinary Ca excretion, and the decrease in estimated Ca balance. Comparison of phase order demonstrated that MPA prevented 24-h urinary Ca excretion and urinary hydroxyproline loss and decline in estimated Ca balance when it was added back during the second 12 weeks (protocol B) but not during the first 12 weeks (protocol A). Conclusion(s): We conclude that sequential MPA appears to reverse in part the negative effects of GnRH-a on calcitropic hormones and estimated Ca balance.

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KW - Gonadotropin-releasing hormone agonist

KW - Medroxyprogesterone acetate

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