Progressive trabecular osteopenia in women with hyperprolactinemic amenorrhea

Abstract

Reductions in cortical and trabecular bone mass have been documented in young women with hyperprolactinemic amenorrhea. It is unknown whether trabecular osteopenia is progressive or reversible with treatment of hyperprolactinemia. In addition, it is not known whether clinical or hormonal variables can predict trabecular bone density (BD) changes. Therefore, we investigated prospectively trabecular BD by computed tomography in 52 hyperprolactinemic women and 41 controls. The mean follow-up interval was 1.8 +/- 0.1 (SEM) yr. Patient groups were defined as follows: group 1, amenorrhea during the entire study; group 2, restoration of menses during the study by treatment of hyperprolactinemia; group 3, regular menses despite hyperprolactinemia, with no history of prior amenorrhea; group 4, history of prior amenorrhea, but menses restored with treatment of hyperprolactinemia before study entry; and group 5, oligomenorrhea. Groups 1, 2, and 4 had significant (P = 0.0006) initial spinal osteopenia [mean BD 141 +/- 7 (SEM), 144 +/- 9, and 151 +/- 5 mg/cc K2HPO4, respectively] compared with controls or with group 3 (170 +/- 4 and 173 +/- 8 mg/cc K2HPO4, respectively). Group 5 had an initial mean BD which was midway between that of the amenorrheic and eumenorrheic women (156 +/- 13 mg/cc K2HPO4). Group 1 had a significant (P = 0.04) decrease in mean BD to 132 +/- 8 mg/cc K2HPO4 over 1.7 +/- 0.2 yr, with BD in 42% of the group more than 2 SD below the control mean at the final study point. The mean BD in group 2 increased to 155 +/- 9 mg/cc K2HPO4, approaching significance (P = 0.07) when compared with the initial BD. Five of the nine patients in this group (56%) had an increase in BD greater than the variation expected for the computed tomography technique. However, 44% of the group 2 patients had a spinal BD which remained more than 1 SD below the normal mean. There was no change in BD in the other groups.(ABSTRACT TRUNCATED AT 400 WORDS)

From Galactorrhea to Osteopenia: Rethinking Serotonin–Prolactin Interactions

“…Hypoestrogenemia as a requisite for osteopenia in women is supported by studies showing that hyperprolactinemic women with normal menstrual cycles do not show decreased bone density (Ciccarelli et al, 1988;Klibanski et al, 1988;Schlechte et al, 1992;Wardlaw and Bilezikian, 1992). One study reports that hyperprolactinemic women who were amenorrheic for less than a year did not have significant bone loss (Cann et al, 1984), and several studies indicate an absence of continued bone loss even when exposure to elevated PRL levels occurs over several years (Biller et al, 1992;Koppelman et al, 1984;Schlechte et al, 1992). However, there are no definitive data describing what duration or degree of elevated PRL levels are necessary to result in decreased bone density.…”

“…Bone loss, once established, may persist after resolution of hyperprolactinemia, indicating that even transient elevations in PRL may be an important risk factor for osteoporosis (Biller et al, 1992;Di Somma et al, 1998;Schlechte et al, 1987Schlechte et al, , 1983. Hyperprolactinemia in adolescents is associated with persistent bone loss (Coelho et al, 1999).…”

High Physiological Prolactin Induced by Pituitary Transplantation Decreases BMD and BMC in the Femoral Metaphysis, but Not in the Diaphysis of Adult Female Rats

“…Our findings could be physiologically relevant, since chronic exposure to high physiological PRL for a few months, similar to that occurring during pregnancy, does not usually induce overt osteopenia in rats and humans [12,20,21]. On the other hand, long-term exposure to pathological hyperprolactinemia (up to ~1,000 ng/ml), such as in prolactinoma or prolonged antipsychotic drug uses, leads to massive bone loss and increased risk of osteoporosis [22][23][24].…”

Estados hiperprolactinêmicos: inter-relações com o psiquismo

“…O grau de hipogonadismo é geralmente proporcional à elevação da prolactina (Serri et al, 2003). Redução da massa óssea, levando a osteopenia e osteoporose, pode ocorrer em mulheres com hipogonadismo associado à hiperprolactinemia (Biller et al, 1992).…”