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Osteoporosis associated with megestrol acetate.
Robert A Wermers1, Daniel L Hurley, Ann E Kearns
1Division of Endocrinology, Diabetes, Metabolism, and Nutrition and Internal Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn 55905, USA. wermers.robert@mayo.edu
Mayo Clinic Proceedings
|December 15, 2004
Summary
High-dose megestrol acetate, used for cancer and wasting, may cause severe osteoporosis and fractures. Adrenal axis suppression was observed but reversible upon discontinuation.
Area of Science:
- Endocrinology
- Oncology
- Metabolic Bone Disease
Background:
- Megestrol acetate is a progestational agent used for metastatic breast and endometrial cancers.
- It also serves as an appetite stimulant for cachexia and relieves hot flashes.
- Megestrol exhibits glucocorticoid-like effects and suppresses estradiol levels.
Observation:
- Two patients presented with severe osteoporosis and multiple vertebral fractures.
- These fractures occurred during high-dose megestrol acetate therapy.
- Patients showed evidence of adrenal axis suppression.
Findings:
- Megestrol acetate therapy was associated with severe osteoporosis and fractures in the observed cases.
- Adrenal axis suppression was noted in these patients.
- Skeletal health recovered after megestrol acetate discontinuation.
Implications:
- Megestrol acetate may adversely affect bone health, potentially leading to osteoporosis and fractures.
- Further research is needed to elucidate the relationship between megestrol acetate and skeletal complications.
- Clinicians should consider bone density monitoring in patients on long-term, high-dose megestrol acetate therapy.