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PubMed1993

The action of anabolic steroids on bone in experimental animals.

Anabolic steroids are currently used in the treatment of established osteoporosis. It has been demonstrated that, at least partly, anabolic steroids increase bone density by stimulating bone formation. Very little is known about how anabolic steroids affect bone in experimental animals. Because bone studies in animals have been performed only with the anabolic steroid nandrolone, or its long-acting ester nandrolone decanoate (ND), we present a general overview in this paper of the effect of these anabolic agents in various steroid-affected animal models for osteoporosis, viz. gonadectomized rats, heparin-treated mice and intact or ovariectomized dogs. In rats and mice these agents increase longitudinal and periosteal bone growth and bone mass, thus demonstrating their anabolic action. They also decrease trabecular bone resorption in ovariectomized and orchidectomized rats, which indicates that they have anti-catabolic effects. In ovariectomized rats, ND was found to increase the mechanical strength of cortical bone, which is an important property in a drug that is intended to be used in treating established osteoporosis. In elderly dogs, ND was found to stimulate endosteal bone formation. These findings indicate that nandrolone and ND have beneficial effects on bone in both oestrogen and androgen-deficient animals.

Anabolic Agents↗
PubMed1997

Anabolic androgenic steroids increase beta-endorphin levels in the ventral tegmental area in the male rat brain.

The levels of beta-endorphin and Met-enkephalin-Arg-Phe (MEAP) immunoreactivity in various brain regions (including amygdala, cortex, hippocampus, hypothalmus, nucleus accumbens, pituitary and ventral tegmental area) were studied in male rats subjected to daily intramuscular injections during 14 days of high doses (5 and 15 mg/kg) of the anabolic androgenic steroid (AAS), nandrolone decanoate. At the nandrolone dose of 15 mg/kg a significant (about 20-fold) increase in beta-endorphin levels in the ventral tegmental area (VTA) was observed. The steroid did not significantly affect the concentration of the peptide at any dose in other brain areas examined. The levels of MEAP remained unaltered in all studied regions. A slight increase in serum concentrations of both peptides was also found but this elevation was not statistically significant. The observed increase in beta-endorphin in VTA was suggested to be involved in a mechanism by which the steroid may influence the reward system in the brain. An opioid mediated stimulation of the reward system following injection of AAS supports a previous hypothesis that AAS may induce psychological dependence.

Anabolic Agents↗
PubMed1991

Androgens potentiate the effects of erythropoietin in the treatment of anemia of end-stage renal disease.

Since androgens may increase the sensitivity of the erythroid progenitors to erythropoietin, the present studies were designed to investigate the effect of administration of androgens on the actions of exogenous erythropoietin (EPO) in hemodialysis patients. Studies were performed in a group of 15 adult male hemodialysis patients. Seven patients were treated with EPO alone at a dose of 2,000 U intravenously (IV) three times a week. An additional group of eight patients was treated with 2,000 U of EPO three times a week and also received 100 mg of nandrolone decanoate intramuscularly (IM) each week. After 12 weeks of therapy, hematocrit values increased slightly in the group receiving EPO alone, from 25.3 +/- 0.8 to 27.4 +/- 1.5. In contrast, EPO in combination with nandrolone decanoate resulted in a greater increase in hematocrit values, from 24.4 +/- 1.4 to 32.9 +/- 1.8 (P less than 0.001). The results show that the groups receiving low-dose EPO alone had a poor erythropoietic response. In contrast, patients receiving androgen in addition to EPO had a significantly greater increase in hematocrit values with treatment. Transfusions were eliminated in both groups of patients. These data show that androgen therapy significantly augments the action of exogenous EPO such that lower doses of EPO are sufficient for an adequate hematopoietic response.

Anabolic Agents↗
PubMed2000

Anabolic steroid and gender-dependent modulation of cytosolic HSP70s in fast- and slow-twitch skeletal muscle.

Besides their clinical uses, anabolic steroids (AASs) are self-administered by athletes to improve muscle mass and sports performance. The biological basis for their presumed effectiveness at suprapharmacological doses, however, remains uncertain. Since the expression of high levels of some stress proteins (HSPs) has been associated with an increased tolerance to stress and chronic exercise up-regulates HSP72 in skeletal muscle, this investigation was aimed at testing whether the administration of suprapharmacological doses of AASs, either alone or in conjunction with chronic exercise, induced changes in HSP72. Nandrolone decanoate (ND), an estrene derivative, but not stanozolol (ST), a derivative of the androstane series, up-regulated the levels of HSP72 and changed the proportions of various charge variants of the cytosolic HSP70s in sedentary and exercise-trained rats, exclusively in fast-twitch fibres. Since the expression of HSP73-levels in skeletal muscle was dependent on gender but not on muscle type, and that of HSP72-levels was muscle type specific but gender-independent, ND effects on cytosolic HSP70s could not be explained solely by a functional relationship with sex steroids. The reported results indicate that, by up-regulating the expression levels of HSP72 in fast-twitch fibres, nandrolone decanoate could contribute to improving the tolerance of skeletal muscle to high-intensity training.

Anabolic Agents↗
PubMed2002

Randomized prospective comparison between erythropoietin and androgens in CAPD patients.

BACKGROUND: Anemia and malnutrition are significant complications in peritoneal dialysis (PD) patients. Previous studies in hemodialysis have shown that androgens are effective as therapy for anemia; however, this has not been tested in a randomized prospective trial in PD patients. Furthermore, the anabolic properties of androgens may exert additional benefits on the nutritional status in this population. METHODS: Twenty-seven stable male patients over 50 years who were under maintenance continuous ambulatory peritoneal dialysis (CAPD) therapy were randomized to receive recombinant human erythropoietin (rHuEPO; N = 14) or nandrolone decanoate (ND; 200 mg/week IM; N = 13) as therapy for anemia. The evolution of hematologic parameters and the impact on both nutritional anthropometric and biochemical variables were evaluated after six months of treatment. RESULTS: Hemoglobin and hematocrit experienced similar increases in both groups: from 8.5 +/- 0.9 g/dL and 25.8 +/- 2.7% to 11.7 +/- 0.6 g/dL and 34.7 +/- 1.6% (P < 0.001) in patients receiving rHuEPO, and from 8.9 +/- 0.8 and 27 +/- 2.2% to 11.8 +/- 0.4 g/dL and 35.1 +/- 1.5% (P < 0.001) in subjects treated with ND. At the end of the study, out of the diverse nutritional variables included in this investigation, only weight and body mass index significantly increased in the rHuEPO group. Conversely, both anthropometric [weight, body mass index, triceps skinfold, mid-arm circumference (MAC) and mid-arm muscle circumference (MAMC)] and biochemical parameters (serum total proteins, albumin, prealbumin and transferrin) were significantly increased in patients treated with ND. In this group, serum urea nitrogen, urea net excretion and protein equivalent of nitrogen appearance significantly decreased. These facts, together with an increase in serum creatinine and no changes in dietary intake during the study, suggest a rise in muscle mass related to an anabolic effect of nandrolone decanoate. Interestingly, serum levels of insulin-like growth factor type 1 (IGF-1) increased in patients on the androgen group compared to subjects treated with rHuEPO. Moreover, there was a positive and significant correlation between the rise in IGF-1 concentrations and the increase in hemoglobin, hematocrit, MAC and MAMC. CONCLUSIONS: Androgens therapy improved the anemia in elderly male CAPD patients in a similar manner to that observed with rHuEPO. Furthermore, compared with rHuEPO, androgen administration was associated with beneficial effects on nutritional status. The mechanism of action of androgens on hematologic and nutritional parameters might be mediated, at least in part, by IGF-1.

Aged↗
PubMed1981

A comparison of androgens for anemia in patients on hemodialysis.

To compare the erythropoietic effects of nandrolone decanoate, testosterone enanthate, oxymetholone, and fluoxymesterone, we performed a randomized clinical trial in patients with anemia who were receiving maintenance hemodialysis (the women were not given testosterone enanthate). After a control period of at least two months, patients received one of the drugs for six months and then returned to control status; a second and third drug were administered in a similar fashion. Seventy-seven patients completed the first drug period, 56 the second, and 35 the third. The response to nandrolone and testosterone enanthate, the two drugs given by injection, was clearly superior to the response to oxymetholone or fluoxymesterone, given by mouth, in terms of the percentage of patients responding and the mean rise in hematocrit. Approximately half the patients had an increase of at least 5 percentage points in hematocrit after an injectable androgen was given; more than half the women responded. Patients who required transfusions regularly and those who had bilateral nephrectomies did not respond.

Administration, Oral↗
PubMed1999

Monitoring changes in fat-free mass in HIV-positive men with hypotestosteronemia and AIDS wasting syndrome treated with gonadal hormone replacement therapy.

OBJECTIVE: To compare methods for assessing changes in body composition during gonadal hormone replacement therapy in a group of HIV-positive men with AIDS wasting syndrome. DESIGN: The study included a 21-day, double-blind, randomized, placebo-controlled inpatient intervention and a 12-week open-label intervention. The inpatient intervention included 18 men who were confined to a metabolic ward. Days 1-7 comprised weight stabilization and body composition measures followed by 14 days of nandrolone decanoate at either 65 or 195 mg weekly, or placebo, and repeat testing. The open-label intervention comprised 12 weeks of 200 mg nandrolone decanoate fortnightly with measurements of fat-free mass at 6 and 12 weeks. METHODS: The inpatient intervention measured nitrogen balance from 24 h urine and fecal collections and fat-free mass by dual energy x-ray absorptiometry (DEXA), bioimpedance spectroscopy (BIS) and D2O dilution. Nitrogen balance was calculated as the difference between dietary intake and urinary and fecal nitrogen excretion. Nitrogen was converted to fat-free mass using the constant of 32.5 g. Repeated measures analysis of variance was used to determine which methods were significantly different from the reference nitrogen balance technique. RESULTS: Nitrogen accretion of lean tissue was 0.55 and 0.85 kg weekly for low and high-dose groups, respectively. Estimated nitrogen retention during the open-label study was 0.42 kg weekly. Body weight increased with the estimated lean tissue accretion. DEXA, BIS and D2O methods demonstrated improvements in fat-free mass, although the BIS estimate of fat-free mass most closely matched the results of the nitrogen retention method. CONCLUSION: DEXA, BIS and D2O techniques demonstrated increases in fat-free mass. The BIS method is less costly, more convenient to use, and had results that more closely matched those from nitrogen balance and retention methods. BIS may be the preferred method to monitor changes in fat-free mass in AIDS patients and patients with malnutrition.

Anabolic Agents↗
PubMed1982

Effect of an anabolic steroid on nitrogen balance and amino acid patterns after total hip replacement.

The effect of an anabolic steroid, nandrolone decanoate, on nitrogen balance and plasma and muscle amino acid concentrations was studied in patients undergoing total hip replacement and receiving daily postoperative infusions of 5% dextrose and 3.5% amino acids. An intramuscular injection of 200 mg immediately after operation resulted in a nitrogen balance of -48 mg N/kg . day for the first 3 days, as compared to 102 mg N/kg . day in noninjected controls. After steroid injection there was also an attenuation of trauma-induced changes in amino acid concentrations in muscle but not in plasma. This suggests that nandrolone decanoate may act directly on muscle to reduce the protein catabolism which follows a major form of operative trauma.

Aged↗
PubMed1991

Effects of training and an anabolic steroid on murine red skeletal muscle. A stereological analysis.

The purpose of this study was the evaluation of changes induced by training (swimming 1 h/day, 5 days/week, 6 weeks) and an anabolic hormone (nandrolone decanoate, intramuscular injections of 15 mg.kg-1 per week) on fiber size, capillarization and mitochondrial fraction of murine soleus muscle. The animals (n = 32) were divided into 4 groups: a control group (C), that received the arachis oil carrier; a steroid group (S), that received the hormone; a training group (T), and a group that was submitted to training and to the administration of hormone (S + T). The soleus muscle was selected for quantitative light- and electron-microscopic evaluation. The muscle fiber size was increased in group T and decreased in groups S and S + T. The axial length of capillaries per unit volume of muscle decreased significantly in groups S and T. The number of capillaries per number of fibers showed a significant decrease in groups S and S + T and an increase in group T. The mitochondrial content decreased in group S, which suggested that anabolic steroids can be harmful for these organelles. This hypothesis was confirmed by histological evaluation at the electron-microscopic level. Many swollen and disrupted mitochondria were found in groups S and S + T. The results suggest that administration of nandrolone decanoate may have some deleterious effects on the muscle respiratory system (capillaries and mitochondria).

Animals↗
PubMed1988

Prospective controlled study of androgen therapy in the anemia of chronic renal disease: effects on iron kinetics.

Ferrokinetic and RBC mass determinations were made at 3-month intervals in iron-replete hemodialysis patients randomized to a control group or to nandrolone decanoate therapy. After 3 months, RBC mass increased in two of 4 androgen-treated patients. Erythron iron turnover, an index of RBC production, increased in the one responder studied but not in the two nonresponders. Similarly, in a fifth subject, who was not restudied until 6 months of androgen therapy were completed, an increase in RBC mass was associated with an increase in erythron iron turnover. However, between 3 and 6 months, RBC mass increased in all 4 androgen-treated patients studied even though erythron iron turnovers remained unchanged and dialysis-associated blood losses did not decrease. Thus, at least two androgen-treated patients had increases in RBC mass without ever increasing their erythron iron turnover. Two of three control subjects also had increased erythron iron turnovers, which in one case was related to increased dialysis-associated blood losses. Changes in RBC mass were not consistently paralleled by changes in Hb. These findings suggest that increases in RBC mass during nandrolone decanoate therapy result from two mechanisms: increased erythropoiesis (shown by simultaneous increases in RBC mass and erythron iron turnover) and increased RBC survival (indirectly shown by increases in RBC mass without increases in erythron iron turnover). The importance of control groups, RBC mass determinations and the monitoring of dialysis-associated blood losses in studying the effects of androgens on erythropoiesis in chronic hemodialysis patients is also demonstrated.

Anemia↗
PubMed1995

Physiologic effects of nutritional support and anabolic steroids in patients with chronic obstructive pulmonary disease. A placebo-controlled randomized trial.

Nutritional depletion commonly occurs in patients with COPD, causing muscle wasting and impaired physiologic function. Two hundred seventeen patients with COPD participated in a placebo-controlled, randomized trial investigating the physiologic effects of nutritional intervention alone (N) for 8 wk or combined with the anabolic steroid nandrolone decanoate (N + A). Nandrolone decanoate or placebo (P) was injected intramuscularly (women, 25 mg; men, 50 mg) in a double-blind fashion on Days 1, 15, 29, and 43. Nutritional intervention consisted of a daily high caloric supplement (420 kcal; 200 ml). Also, all patients participated in an exercise program. In the depleted patients, both treatment regimens induced a similar significant body weight gain (2.6 kg) but different body compositional changes. Particularly in the last 4 wk of treatment, weight gain in the N group was predominantly due to an expansion of fat mass (p < 0.03 versus P and N + A), whereas the relative changes in fat-free mass (FFM) and other measures of muscle mass were more favorable in the N + A group (p < 0.03 versus P). Maximal inspiratory mouth pressure improved within both treatment groups in the first 4 wk of treatment, but after 8 wk only N + A was significantly different from P (p < 0.03). Nutritional supplementation in combination with a short course of anabolic steroids may enhance the gain in FFM and respiratory muscle function in depleted patients with COPD without causing adverse side effects.

Anabolic Agents↗
PubMed2004

Endocrinological and pathological effects of anabolic-androgenic steroid in male rats.

Many athletes use drugs, especially anabolic androgenic steroids (AAS), but there are few reports on the endocrinological and pathological changes in AAS abusers. In this study we reported the results of endocrinological examinations in rats administered AAS and also physical changes. We separated 37 male Wistar rats (7 weeks old) into 3 groups: Group A was medicated with nandrolone decanoate, metenolone acetate, and dromostanolone; Group B with nandrolone decanoate and saline; and Group C was given only saline. They were given subcutaneous injections of the medications or the control vehicle once a week for 6 weeks. Medications were stopped for 4 weeks, and then resumed for another 6 weeks. After that, rats were sacrificed. Serum testosterone level in Group A was significantly higher than that in Group C. Serum dihydrotestosterone in Group A was significantly higher than that in both Groups B and C. Serum estradiol-17beta levels in Groups A and B were significantly higher than that in Group C. In pathological evaluation, heart, testis, and adrenal gland were severely damaged. These findings indicate that there is a high degree of risk related to the use of AAS.

Adrenal Glands↗
PubMed1985

Experimental work with anabolics in autoimmunity models.

19-nortestosterone (nandrolone) or its decanoate was tested in six animal models for autoimmune disease. The compound was found capable of inhibiting the development of disease symptoms or the deterioration of certain immune parameters in three out of five models of spontaneous autoimmune disease: NZB/NZW F1 (NZB/W) mice (lupus glomerulonephritis, Sjögren's disease-like syndrome), NZB (lupus glomerulonephritis, autoimmune haemolytic anaemia) and OS chickens (thyroiditis). No effect of the compound was seen in MRL lpr/lpr mice (lupus glomerulonephritis, lymphoproliferative disease) and in BB rats (insulin-dependent diabetes mellitus; IDDM). Nandrolone decanoate also seems to be active in myasthenia gravis evoked in rats immunised with acetylcholine receptor but further experiments are necessary to confirm this. In a first experiment also ethylestrenol was found to give favourable effects in the model.

Animals↗
PubMed1999

Effects of anabolic steroid (19-nortestosterone) on the secretion of testicular hormones in the stallion.

The aim of this study was to clarify the effect of anabolic steroids on the testicular endocrine function of mature stallions. Mature thoroughbred stallions were treated with 800 mg nandrolone decanoate every 3 weeks for 3 months. After the first treatment, plasma concentrations of LH, immunoreactive inhibin and testosterone decreased rapidly to the nadir. These hormones were maintained at significantly lower concentrations compared with concentrations in intact stallions. Histology of the testicular tissue indicated the arrest of advanced spermatogenesis in the seminiferous tubules and a severe depletion of the number of Leydig cells in the interstitial compartment as a result of treatment. Most of the immunopositive cells for the inhibin alpha-subunit and steroidogenesis enzymes in the interstitial compartment decreased below detectable amounts, whereas immunopositive reactions of inhibin alpha-subunit in the seminiferous tubules were clearly observed. In conclusion, the treatment of mature stallions with nandrolone decanoate caused a decrease in the secretion of ir-inhibin and testosterone from the testis, the depletion of the number of Leydig cells and a decrease below detectable amounts of inhibin alpha-subunit and steroidogenesis enzymes. The concentration of ir-inhibin in the peripheral blood may be a useful marker for the examination of testicular activity in stallions being treated with anabolic steroids.

3-Hydroxysteroid Dehydrogenases↗
PubMed1996

Effects of androgen therapy on prostatic markers in hemodialyzed patients.

We have prospectively studied the evolution of serum levels of the prostatic-specific antigen and prostatic acid phosphatase in 14 male hemodialyzed patients, receiving a cycle of nandrolone decanoate (200 mg intramuscularly, once a week, for six months) as treatment for anemia. Androgen administration did not produce significant increases in serum concentrations of both tumor markers (basal: 0.9 +/- 0.5 and 0.7 +/- 0.3 ng/ml; at six months: 1.3 +/- 1.1 and 0.8 +/- 0.7 ng/ml respectively). Only one patient had a value of prostatic-specific antigen over the normal range: 4.2 ng/mol at the sixth month period, with a rapid decrease after the withdrawal of androgens. All the remaining values of both markers were within the normal range. In another six patients undergoing a prolonged treatment with androgens (between 9 to 24 months), the serum levels of prostatic-specific antigen and prostatic acid phosphatase were within the normal range in all of them. Nandrolone decanoate administration does not induce increases in prostate tumor markers when it is used as treatment for anemia in hemodialyzed patients.

Acid Phosphatase↗
PubMed1994

Anabolic steroids in the treatment of malnourished CAPD patients: a retrospective study.

OBJECTIVE: To assess the effect of anabolic steroids on malnutrition of continuous ambulatory peritoneal dialysis (CAPD) patients. DESIGN: Retrospective analysis of medical records, charts, and computer-generated laboratory and medication data. SETTING: Peritoneal Dialysis Unit of The Toronto Hospital. PATIENTS: Thirteen patients with moderate to severe malnutrition who had received nandrolone decanoate (ND) intramuscularly (IM) for at least three months. Nine of these patients (group A), with a mean age of 59.4 years, received only ND (100-200 mg IM monthly). Group B consisted of 4 patients (mean age 74.0 years) who, in addition to ND, received intraperitoneal (IP) amino acids. RESULTS: In group A, serum albumin, while declining before ND treatment (34.4 +/- 3.2 to 31.5 +/- 3.35, x +/- SEM, g/L at -2 and 0 months), showed a progressive and significant (p < 0.001) increase during treatment, sustained up to the third month (36.57 +/- 1.51). In group B, serum albumin did not increase significantly (30.25 +/- 2.62, 30.75 +/- 1.9, and 31.5 +/- 4.8, mean +/- SEM, g/L at -2, 0, and +3 months, respectively. In group A, serum creatinine was increased significantly (p < 0.01) from 0 to +3 months (731 +/- 185 to 938 +/- 92.5 mmol/L). Blood urea, bicarbonate, and total protein levels did not change significantly. In group B, serum creatinine fluctuated considerably with an insignificant trend to rise. Blood urea showed a steady trend to increase without reaching statistical significance. In relation to time 0, bicarbonate levels (28.7 +/- 3.3) were decreased significantly (p < 0.05) (27 +/- 0.8, 24.6 +/- 1.5, and 25 +/- 1 mEq/L, at +1, +2, and +3 months, respectively). CONCLUSIONS: Nandrolone decanoate alone, in relatively low doses, exerted a definite anabolic effect in 9 malnourished CAPD patients. The lack of a similar effect in 4 patients, who in addition to ND received amino acids IP, could be explained by the low dose of ND, the concurrent acidosis, the severity of malnutrition, and the older age of this group.

Adult↗
PubMed1995

Oral anabolic steroid treatment, but not parenteral androgen treatment, decreases abdominal fat in obese, older men.

OBJECTIVE: To compare the effects of testosterone enanthate (TE), anabolic steroid (AS) or placebo (PL) on regional fat distribution and health risk factors in obese middle-aged men undergoing weight loss by dietary means. DESIGN: Randomized, double-blind, placebo-controlled clinical trial, carried out for 9 months with primary assessments at 3 month intervals. Due to adverse blood lipid changes, the AS group was switched from oral oxandrolone (ASOX) to parenteral nandrolone decaoate (ASND) after the 3 month assessment point. SUBJECTS: Thirty healthy, obese men, aged 40-60 years, with serum testosterone (T) levels in the low-normal range (2-5 ng/mL). MAIN OUTCOME MEASURES: Abdominal fat distribution and thigh muscle volume by CT scan, body composition by dual energy X-ray absorptiometry (DEXA), insulin sensitivity by the Minimal Model method, blood lipids, blood chemistry, blood pressure, thyroid hormones and urological parameters. RESULTS: After 3 months, there was a significantly greater decrease in subcutaneous (SQ) abdominal fat in the ASOX group compared to the TE and PL groups although body weight changes did not differ by treatment group. There was also a tendency for the ASOX group to exhibit greater losses in visceral fat, and the absolute level of visceral fat in this group was significantly lower at 3 months than in the TE and PL groups. There were significant main effects of treatment at 3 months on serum T and free T (increased in the TE group and decreased in the ASOX group) and on thyroid hormone parameters (T4 and T3 resin uptake significantly decreased in the ASOX group compared with the other two groups). There was a significant decrease in HDL-C, and increase in LDL-C in the ASOX group, which led to their being switched to the parenteral nandrolone decanoate (ASND) after 3 months. ASND had opposite effects on visceral fat from ASOX, producing a significant increase from 3 to 9 months while continuing to decrease SQ abdominal fat. ASND treatment also decreased thigh muscle area, while ASOX treatment increased high muscle. ASND reversed the effects of ASOX on lipoproteins and thyroid hormones. The previously reported effect of T to decrease visceral fat was not observed, in fact, visceral fat in the TE group increased slightly from 3 to 9 months, although SQ fat continued to decrease. Neither TE nor AS treatment resulted in any change in urologic parameters. CONCLUSIONS: Oral oxandrolone decreased SQ abdominal fat more than TE or weight loss alone and also tended to produce favorable changes in visceral fat. TE and ASND injections given every 2 weeks had similar effects to weight loss alone on regional body fat. Most of the beneficial effects observed on metabolic and cardiovascular risk factors were due to weight loss per se. These results suggest that SQ and visceral abdominal fat can be independently modulated by androgens and that at least some anabolic steroids are capable of influencing abdominal fat.

Adipose Tissue↗
PubMed2004

Pharmacotherapy for patellofemoral pain syndrome.

BACKGROUND: Patellofemoral pain syndrome (PFPS) is common among adolescents and young adults. It is characterised by pain behind or around the patella and crepitations, provoked by ascending or descending stairs, squatting, prolonged sitting with flexed knees, running and cycling. The symptoms impede function in daily activities or sports. Pharmacological treatments focus on reducing pain symptoms (non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticosteroids), or restoring the assumed underlying pathology (compounds containing glucosamine to stimulate cartilage metabolism, anabolic steroids to increase bone density of the patella and build up supporting muscles). In studies, drugs are usually applied in addition to exercises aimed at building up supporting musculature. OBJECTIVES: This review aims to summarise the evidence of effectiveness of pharmacotherapy in reducing anterior knee pain and improving knee function in people with PFPS. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group and Cochrane Rehabilitation and Related Therapies Field trials registers, the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2003), PEDro (up to January 2004), MEDLINE (1966 to January 2004), EMBASE (1988 to January 2004), and CINAHL (1982 to January 2004). SELECTION CRITERIA: Controlled trials (randomised or not) comparing pharmacotherapy with placebo, different types of pharmacotherapy, or pharmacotherapy to other therapies for people with PFPS. DATA COLLECTION AND ANALYSIS: The literature search yielded 780 publications. Eight trials were included, of which three were of high quality. Data were analysed qualitatively using best evidence synthesis, because meta-analysis was impeded by differences in route of administration of drugs, care programs and outcome measures. MAIN RESULTS: Four trials (163 participants) studied the effect of NSAIDs. Aspirin compared to placebo in a high quality trial produced no significant differences in clinical symptoms and signs. Naproxen produced significant short term pain reduction when compared to placebo, but not when compared to diflunisal. Laser therapy to stimulate blood flow in tender areas led to more satisfied participants than tenoxicam, though not significantly. Two high quality RCTs (84 participants) studied the effect of glycosaminoglycan polysulphate (GAGPS). Twelve intramuscular injections in six weeks led to significantly more participants with a good overall therapeutic effect after one year, and to significantly better pain reduction during one of two activities. Five weekly intra-articular injections of GAGPS and lidocaine were compared with intra-articular injections of saline and lidocaine or no injections, all with concurrent quadriceps training. Injected participants showed better function after six weeks, though only the difference between GAGPS injected participants and non-injected participants was significant. The differences had disappeared after one year. One trial (43 participants) found that intramuscular injections of the anabolic steroid nandrolone phenylpropionate significantly improved both pain and function compared to placebo injections. REVIEWERS' CONCLUSIONS: There is only limited evidence for the effectiveness of NSAIDs for short term pain reduction in PFPS. The evidence for the effect of glycosaminoglycan polysulphate is conflicting and merits further investigation. The anabolic steroid nandrolone may be effective, but is too controversial for treatment of PFPS.

Anabolic Agents↗