Correlation Seen Between Lean Body Mass Gain and Wound Healing

March 29, 2001

New York (MedscapeWire) Mar 29 Clinical data on the treatment of involuntary weight loss (IWL) with oxandrolone ( Oxandrin) established a significant correlation between gain of lean body mass and time to closure of nonhealing wounds. The data were presented by Robert Demling, MD, professor of surgery and director of the burn center at Brigham and Women's Hospital (BWH) in Boston, Massachusetts, during a symposium at the annual meeting of the American Medical Directors Association (AMDA).  The study found that the addition of oxandrolone to a nutritional regimen increased restoration of weight by 4 pounds per week in patients with large nonhealing wounds.

According to Demling, there is a body of evidence to suggest that many patients suffering from involuntary weight loss require both enhanced nutrition and anabolic hormone therapy to gain lean body mass, heal pressure ulcers, and reduce morbidity. "Early nutritional intervention is essential for preventing patients at risk, such as those in long term care, from developing pressure ulcers, as well as for healing existing pressure ulcers," Demling stated. "These data show that an optimal opportunity exists for the integration of adjunctive anabolic steroids into the standard line of nutritional therapy for preventing and controlling involuntary weight loss in patients with, or at risk for, non-healing or chronic wounds."

The study of 8 patients with nonhealing wounds of an average of 12 months duration and with weight loss of 10% or more of their body weight demonstrated that optimizing nutrition alone for 4 weeks did not significantly increase weight or healing of wounds. The addition of oxandrolone increased restoration of weight by 4 pounds per week over a 12-week period. Complete wound closure was observed in 5 patients and 75% wound closure was observed in the remaining 3 patients during this period.

IWL, defined as a loss of 10% or more of body weight in 6 months or less, or a loss of more than 5% of body weight in 30 days, can lead to complications that may severely compromise patient health, such as pressure ulcers. This drastic loss disrupts the body's metabolic processes resulting in catabolism, the breakdown of protein.

The rate of wound healing was most prominent after 50% of weight loss had been restored. This finding supports the key relationship between restoring body weight, body protein stores, and wound healing. Further research is necessary before formal conclusions can be reached.

"Anabolic therapies impact patient recovery because they reverse the catabolic state," said Dr. Demling. "In a catabolic state, patients' bodies use muscle proteins to provide energy. This process results in a loss of lean body mass. The loss of lean body mass leads to numerous complications, including pressure ulcers, impaired immunity, urinary tract infections, pneumonia, need for increased assistance with activities of daily living, fractures, and depression."

Residents in long-term-care facilities, home-care patients, and many elderly patients commonly suffer from "geriatric weight loss syndrome," which is defined as IWL among elderly patients. Up to 85% of residents in nursing homes are prone to significant weight loss. By providing an anabolic stimulus, oxandrolone helps reverse geriatric weight loss syndrome by moving the patient out of the catabolic state, restoring lean body mass, and promoting tissue repair as part of the healing process.

Oxandrolone is the only oral anabolic steroid that has been approved by the US Food and Drug Administration as adjunctive therapy to promote weight gain after weight loss following extensive surgery; chronic infections; severe trauma; in some patients who without definite pathophysiologic reasons fail to gain or maintain normal weight; and to offset protein catabolism associated with prolonged administration of corticosteroids. Therapy with anabolic steroids is adjunctive to and not a replacement fooor conventional therapy. The usual adult dosage of oxandrolone is one 2.5-mg tablet twice to 4-times daily. However, the response of individuals to anabolic steroids varies, and a daily dosage of as little as 2.5 mg or as much as 20 mg may be required to achieve desired response.

The contraindications for oxandrolone are known or suspected carcinoma of the prostate or male breast; carcinoma of the breast in women with hypercalcemia (androgenic anabolic steroids may stimulate osterolytic bone resorption); pregnancy, because of possible masculinization of the fetus (Oxandrin has been shown to cause embryotoxicity, fetotoxicity, infertility, and masculinization of female animal offspring when given in doses 9 times the human dose); nephrosis, the nephrotic phase of nephritis; and hypercalcemia. Certain conditions have been reported in patients receiving androgenic anabolic steroid therapy including peliosis hepatitis, liver cell tumors and blood lipid changes associated with increased risk of athereosclerosis.

The symposium was supported by an unrestricted grant from the Ross Products Division of Abbott Laboratories, comarketers of Oxandrin.

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