This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Endometriosis, Adenomyosis, Subject name: Gynaecology & Obstetrics
All of these are true about GnRH analogues used in treatment of endometriosis , EXCEPT? 
Select and explain. 
A. Continuous administration causes downregulation of pituitary gonadotropins, B. The risk of osteoporosis decreases with prolonged use as the estrogen mediated osteoblastic action continues, C. Add back therapy includes estrogens, D. Discontinuation causes recurrence
B: The risk of osteoporosis decreases with prolonged use as the estrogen mediated osteoblastic action continues
Answer: B: The risk of osteoporosis decreases with prolonged use as the estrogen mediated osteoblastic action continues 
Explanation: GnRH is given continuously to downregulate and suppress pituitary gonadotropins and cause atrophy of endometriotic tissue. The risk of osteoporosis increases after prolonged use as the estrogen mediated osteoblastic action stops while the estrogen independent osteoclast action continues Add back therapy is given to reduce the risk of hypoestrogenic side effects like osteoporosis, hot flushes, vaginal dryness, urogenital atrophy. Drugs include: progesterones, low dose estrogens, tibolone Discontinuation causes recurrence within a year in upto 50 % cases Commonly used GnRH agonists are: Leuprolin Naferelin Goserelin Buserelin