Гормональная терапия эндометриоза снижает минеральную плотность костей у пациенток

Hormonal suppression therapy for endometriosis is associated with reduced bone mineral density (BMD) after 12 months, with the magnitude of loss varying by drug class, according to study findings published in Obstetrics & Gynecology. Endometriosis affects about 10% of reproductive-aged women and people assigned female at birth, presenting with symptoms ranging from asymptomatic to severe pelvic pain and infertility. While long-term estrogen-suppressive hormonal therapy is the first-line treatment for symptom control, it may reduce BMD; however, the exact clinical significance of these BMD changes remains uncertain. To determine whether these hormonal treatments cause significant bone loss, researchers conducted a systematic review and meta-analysis aimed at examining the effects of medical therapies for endometriosis on bone health. The meta-analysis included 37 of 1153 screened studies (including 28 randomized controlled trials [RCTs], 6 prospective cohort studies, and 3 retrospective cohort studies) with women of reproductive age who received hormonal treatments for endometriosis across 12 countries, including the United States, the United Kingdom, Germany, South Korea, China, Japan, Italy, France, the Netherlands, Sweden, and Switzerland from database inception to July 2025. This highlights the need for standardized guidance in the management and surveillance of bone health. The researchers searched clinical trial databases, including Ovid MEDLINE, Ovid EMBASE, PubMed, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov, for studies reporting the effects of hormonal treatments for endometriosis on BMD. Assessed interventions included gonadotropin-releasing hormone (GnRH) agonists, dienogest, GnRH antagonists, and depot medroxyprogesterone acetate (DMPA). The primary endpoint was BMD assessed after 6 months of treatment. The secondary endpoint was BMD at 12 months. Pooled analyses demonstrated that GnRH agonists with add-back therapy were associated with reduced BMD in 348 patients across 11 studies at 6 months (-0.89%; 95% CI, -1.45 to -0.33; I²=20.3%) and 215 patients across 4 studies at 12 months (-1.50%; 95% CI, -2.68 to -0.31; I²=40.5%). Subgroup analysis showed a significant BMD reduction with leuprolide in 279 patients across 6 studies (-1.33%; 95% CI, -1.92 to -0.74; I²=0%), whereas the smaller reduction with goserelin in 69 patients across 5 studies was not significant (-0.42%; 95% CI, -1.00 to 0.16; I²=11%); both formulations were noted by study authors to decrease BMD. Tibolone, estrogen-progestin, and progestin-only add-back regimens provided comparable BMD protection. Therapy with dienogest was associated with reduced BMD in 273 patients across 6 studies at 6 months (-0.83%; 95% CI, -1.52 to -0.15; I²=76.8%; 6 studies) and in 241 patients across 4 studies at 12 months (-1.91%; 95% CI, -2.58 to -1.24; I²=83.7%), although substantial heterogeneity and inconsistency were observed. GnRH antagonists were associated with a 2.17% reduction in BMD in 1311 patients across 5 studies (95% CI, -3.44 to -0.90; I²=97.3%). Researchers evaluated elagolix, linzagolix, and relugolix. Data for DMPA could not be pooled for meta-analysis due to incomplete reporting of variability measures. Study limitations included the small number of studies for certain drug therapies, high heterogeneity, and inconsistent reporting of demographic and BMD variability data. The study authors concluded, “The clinical significance of a reduction in BMD of 1[% to] 2% remains to be determined and needs to be carefully weighed against the therapeutic benefit because long-term hormonal therapy remains the cornerstone for treatment for endometriosis. This highlights the need for standardized guidance in the management and surveillance of bone health.” References: Desilets J, Lakabi R, Olsthoorn A, et al. Effect of medical therapies for endometriosis on bone health: a systematic review and meta-analysis. Obstet Gynecol. Published online August 2, 2026. doi:10.1097/AOG.0000000000006241