The impact of long-term suppressive therapy with gonadotropin-releasing hormone agonists on bone tissue status in female patients

The article presents a systematization and critical analysis of current clinical and experimental data on the effects of long-term suppressive therapy with gonadotropin-releasing hormone class drugs on bone tissue status in women of reproductive and perimenopausal age, with particular emphasis on patients with endometriosis as one of the key clinical groups requiring prolonged hormonal treatment. The study was conducted as a narrative literature review, incorporating randomized controlled trials, meta-analyses, systematic reviews, and post-marketing surveillance data. Particular attention is paid to the dependence of bone loss severity on dosage, drug class, and treatment duration. The role of hypoestrogenism and the direct effects of gonadotropin-releasing hormone receptors in bone tissue in the pathogenesis of drug-induced osteopenia is examined. It is emphasized that the decrease in bone mineral density is dose-dependent and may be partially irreversible, which is of particular clinical relevance in the long-term management of endometriosis. Molecular mechanisms underlying the imbalance between osteoblastogenesis and osteoclastogenesis via the RANKL/OPG system are elucidated. The necessity of mandatory inclusion of add-back therapy in long-term treatment regimens is substantiated. It has been demonstrated that oral gonadotropin-releasing hormone antagonists, when combined with add-back therapy, provide the best balance between clinical efficacy and skeletal safety, particularly in patients with endometriosis. The consistency of post-marketing surveillance data with the results of randomized studies is confirmed. The conclusion highlights the importance of an individualized approach to drug selection and mandatory monitoring of bone mineral density throughout the entire course of therapy.

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