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PART
- 3
Anabolic
and Wound Healing Effects of the Testosterone Analog
Oxandrolone in the Wound Patient (Current Evidence)
OXANDROLONE,
AN ANABOLIC STEROID, SIGNIFICANTLY INCREASES THE RATE OF
WEIGHT GAIN IN THE RECOVERY PHASE AFTER MAJOR BURNS
Robert
H. Demling, M.D. and Leslie DeSanti, RN
We
studied the effect of an anabolic steroid, oxandrolone,
combined with a high-protein diet (2 g/kg/day) on the
rate of weight gain and restoration of muscle function
in the recovery phase after deep burns of 30 of 50% of
total body surface (n = 7). The findings were compared
with findings from an isocaloric (2 g/kg/day protein)
diet alone (n = 6). The study was prospective and
randomized. Data were also compared retrospectively with
data from a group of burn patients treated in the same
fashion using a high-calorie, high -protein diet with a
protein content of 1.3 to 1.4 g/kg/day (n = 10). Muscle
function was quantified using a physical therapy index
defining rate of progress (0 = lowest, 10 = highest).
Oxandrolone was given in the beginning of the recovery
phase in a dosage of 10mg orally twice a day.
The
recovery phase was defined as resolution of the
hypermetabolic state using physiologic criteria. The
study was performed in an acute burn rehabilitation
facility where patients were transferred once entering
the recovery phase.
Patients
in each group were not different with regard to age and
burn size. We found that mean weight loss for all
patients was 11± 2% of preburn weight during the
catabolic phase despite optimum nutrition and early
wound closure. Data are presented as mean ± SD. We
found that the average weight gain during the first 3
weeks was 14.5± 2.5 pounds and that the physical
therapy index was 8.8± 0.5 of recovery in the
oxandrolone-protein group (n = 7); both of theses values
were significantly greater than the corresponding values
in the other groups. In the high-protein alone group (n
= 6), weight gain was 7.5± 1.7 pounds and physical
therapy index was 7.0± 0.8. In the retrospective group
(n = 10), weight gain was 4.4± 0.8 pounds and function
index was 4.1± 0.5. The daily caloric intake was not
different between groups. Protein content and
oxandrolone were the variables. No side effects were
noted with oxandrolone.
We can
conclude that an anabolic steroid combined with
increased protein intake can significantly increase the
rate of restoration of weight gain postburn. (J
Trauma 1997; 43:47-50)
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THE
ANTICATABOLIC AND WOUND HEALING EFFECTS OF THE
TESTOSTERONE
ANALOG OXANDROLONE AFTER SEVERE BURN INJURY
Robert H.
Demling, MD, Dennis P. Orgill, MD, PhD
The
Burn Center, Brigham and Women’s Hospital and Harvard
Medical School Boston, MA
Purpose:
Severe burn injury leads to marked catabolism and
decreased lean mass which can impair healing. Anabolic
agents can attenuate net catabolism. Our purpose was to
determine whether the testosterone analog, oxandrolone,
given during the acute post burn period decreased the
degree of nitrogen loss and loss of body weight while also
increasing the healing rate of a skin donor site.
Methods:
Patients with burns between 40 and 70% of body surface
were studied. A randomized double ded placebo
controlled study design was used. Patients were given
oxandrolone 20mg/day (n=9) beginning between days 2-3 post
burn. Net nitrogen balance and the healing time of a
standardized donor site were measured. Patients were
monitored until transferred to a burn rehabilitation
facility, an average time period of 33± 9 days.
Results:
Mean burn size was 49± 8% for placebo and 53± 9% of TBS
for the oxandrolone group. Smoke inhalation was present in
approximately 50% of patients in both groups. All patients
survived the burn injury. Net weight loss was 8± 3.1 kg
in the placebo group compared with 3± 1.9 kg in the
oxandrolone group, a statistically significant decrease.
Net daily nitrogen loss over a 3 week period (day 7-28)
was 13± 4 g in placebo treated compared to 4± 1.9 g for
the oxandrolone group, a statistically significant
decrease. The healing time of a standardized donor site,
decreased from the placebo group value of 13± 3 days to 9±
2 days for oxandrolone treated patients, a significant
improvement. No major liver dysfunction, or other
complication attributable to an anabolic steroid was seen
in either group.
Conclusion:
We found, the anabolic agent, oxandrolone significantly
decreased weight loss and net nitrogen loss and increased
donor site wound healing compared to placebo controls. We
noted no complications with the use of oxandrolone. (J
Crit Care, March 2000; 15:12-18)
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COMPARISON
OF THE ANABOLIC EFFECTS AND COMPLICATIONS OF HUMAN
GROWTH
HORMONE
AND THE TESTOSTERONE ANALOG, OXANDROLONE, AFTER SEVERE BURN
INJURY.
The
Burn Center, Brigham and Women’s Hospital and Harvard
Medical School Boston, MA
Abstract
This
study compared the anticatabolic and wound healing effects
of the anabolic agents human growth hormone, HGH, and the
testosterone analogue, oxandrolone, after severe burn
injury. A randomized prospective study design was used.
Patients were given HGH at a dose of 0.1 mg/kg/day (n = 20)
or oxandrolone, 20mg/day (n = 16), beginning between days
7-10 post-burn. Data was compared to burn patients not
placed on either agent (n = 24). Patients were monitored
until they were sufficiently healed to be transferred to a
rehabilitation center.
The
results of our study were as follows: All patients survived.
Net weight loss was 82.1 kg in the control group compared
with 4± 1.8 kg with HGH and 3± 1.2 kg with oxandrolone, a
significant decrease. Net daily nitrogen loss was 12± 3 g
in non-treated compared to 3 g of less for each of the
anabolic groups, a significant decrease. The metabolic rate
in untreated burns was 15525% of predicted normal, compared
to 178± 28% for HGH and 156± 20% for oxandrolone treated
patients. The complete healing time of a standardized donor
site, decreased from the control value of 14± 2 days to 10±
3 days for HGH and 10± 2 days for oxandrolone treated
patients, a significant improvement. Hyperglycemia (glucose
over 225 mg/dl 12.5 mM) was present in 100% of HGH patients
compared to 55% for control and 50% for oxandrolone treated.
We found that
both anabolic agents significantly decreased weight and
nitrogen loss and increased healing with nearly identical
benefits. However HGH resulted in the significant
complications of hyperglycemia and accentuated
hyper-metabolism. We noted no side effects with oxandrolone.
ã 1999 Elsevier Science Ltd and ISBI. (Burns 24;
1999:215-221)
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THE
RATE OF RESTORATION OF BODY WEIGHT AFTER BURN INJURY, USING
THE
ANABOLIC AGENT OXANDROLONE, IS NOT AGE DEPENDENT
Robert
H. Demling, MD and Leslie DeSanti, RN
Burn Center,
Brigham and Women’s Hospital
We
determined the effect of age on the restoration of lost body
weight and lean mass after burn injury, using the anabolic
steroid oxandrolone.
Patients
with deep burns of 30 to 55% of body surface were studied
when entering the recovery phase of injury, defined as
resolution of the hypermetabolic, catabolic state. Patients
were provided optimum nutrition and exercise alone or with
the addition of oxandrolone. The rate of body weight and
lean mass gain and improvement in physical function were
measured over a four week period. Four groups were studied.
A younger group, mean age of 34 years and burn size of 47±
7% versus an older group, mean age 60 years and burn size 36±
5%. The mean loss of body weight in the younger and older
groups was 10± 2 and 11± 2% of total. Both groups were
randomly divided into a control and oxandrolone study group.
Weight
restoration, 74± 5% of which was lean mass, averaged 1.7±
4 kg and 1.6± 3 kg per week in the young and older
oxandrolone groups. This rate was compared with 0.7± 2 kg
and 0.5± 2 kg in the young and older control groups, with
only 55% of weight gain being lean mass. These differences
were statistically significant. The increase in the rate of
weight gain with oxandrolone corresponded with a 30%
decrease in length of stay in the burn rehabilitation unit.
We concluded
that the ability of an anabolic steroid to restore lean
mass and physical function after burn surgery is not
related to age. (Burns, In press, 2000)
EFFECT
OF AGE ON ANABOLIC RESPONSE TO OXANDROLONE AFTER MAJOR
BURN
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OXANDROLONE,
AN ANABOLIC STEROID, ENHANCES
THE
HEALING OF A CUTANEOUS WOUND IN THE RAT
Abstract
We
studied the effect of the anabolic steroid oxandrolone,
on the healing rate of a standardized full thickness
linear wound on the back of the rat. Oxandrolone was
given orally by gavage, in peanut oil in a dose of 0.1
mg/kg/day vs. a placebo powder in peanut oil at the
same dose.
Parameters
monitored were timed to complete closure, wound
hydroxyproline content and tensile strength as well as
histology. We found that wounds completely closed in
12± 3 days with oxandrolone compared to 18± 3 days
for a placebo, a significant difference. The rate of
body weight gain was identical in both groups.
Hydroxyproline content of the healed incision site was
23± 4 mg/gm tissue versus 17± 3 mg/gm tissue, in the
oxandrolone versus placebo group. Tensile strength was
185± 13 gm/mm2 vs 102± 18 gm/mm2
with oxandrolone versus placebo. Both parameters were
significantly increased with the anabolic steroid.
Histology demonstrated a more mature collagen dense
hypercellular wound with oxandrolone.
We
conclude that the anabolic steroid oxandrolone
significantly enhanced wound heali8ng unrelated to any
generalized increase in protein mass as would be
reflected in body weight. (Wound Regeneration and
Repair, March/April 2000)
Skin Biopsy Control
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Figure
1. A typical sample of a wound incision site in
the placebo group is shown in a low power
photomicrograph. The
new collagen shows beginning organization and is
loosely packed compared to the neighboring normal skin
collagen. Moderate cellularity is noted. Findings are
typical of a wound of this time period of healing.
Skin Biopsy
Oxandrolone
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Figure
2. A typical sample of a wound in the oxandrolone
fed group is shown in a lower power photomicrograph.
The healing dermal collagen is more dense and the
wound more cellular than other groups. The wound
histology reflects a more mature healing wound than
the other groups.
  
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