Which medication used for endometriosis can lead to loss of bone mineral density?

Leuprolide (Lupron) is a gonadotropin-releasing hormone (GnRH) agonist used in the treatment of endometriosis. Its mechanism of action involves suppression of estrogen production by initially stimulating and then downregulating the pituitary gland, which ultimately leads to reduced ovarian function. Since estrogen plays a crucial role in maintaining bone density, the prolonged use of GnRH agonists like leuprolide can lead to a decrease in estrogen levels, resulting in a significant loss of bone mineral density. This effect is particularly concerning in premenopausal women, as they are at an increased risk for osteoporosis and related fractures with decreased estrogen exposure.

While other medications used for endometriosis, such as oral contraceptives, dantrolene, and progestational agents, can affect the menstrual cycle and hormonal balance, they typically do not cause the same extent of bone density loss as leuprolide. Oral contraceptives and progestins may actually help maintain bone density by providing a level of estrogen or progestin that can mitigate bone loss. Dantrolene is used more for its muscle relaxant properties and does not have a direct effect on bone density. Therefore, leuprolide is distinct