Smith M R, McGovern F J, Zietman A L, Fallon M A, Hayden D L, Schoenfeld D A, Kantoff P W, Finkelstein J S
Massachusetts General Hospital, Boston 02114, USA.
N Engl J Med. 2001 Sep 27;345(13):948-55. doi: 10.1056/NEJMoa010845.
Treatment with a gonadotropin-releasing hormone agonist decreases bone mineral density and increases the risk of fracture in men with prostate cancer. We conducted a controlled study of the prevention of osteoporosis in men undergoing treatment with a gonadotropin-releasing hormone agonist.
In a 48-week, open-label study, we randomly assigned 47 men with advanced or recurrent prostate cancer and no bone metastases to receive either leuprolide alone or leuprolide and pamidronate (60 mg intravenously every 12 weeks). Bone mineral density of the lumbar spine and the proximal femur was measured by dual-energy x-ray absorptiometry. Trabecular bone mineral density of the lumbar spine was measured by quantitative computed tomography. Forty-one men completed the study.
In men treated with leuprolide alone, the mean (+/-SE) bone mineral density decreased by 3.3+/-0.7 percent in the lumbar spine, 2.1+/-0.6 percent in the trochanter, and 1.8+/-0.4 percent in the total hip, and the mean trabecular bone mineral density of the lumbar spine decreased by 8.5+/-1.8 percent (P<0.001 for each comparison with the base-line value). In contrast, the mean bone mineral density did not change significantly at any skeletal site in men treated with both leuprolide and pamidronate. There were significant differences between the two groups in the mean changes in bone mineral density at 48 weeks in the lumbar spine (P<0.001), trochanter (P = 0.003), total hip (P=0.005), and trabecular bone of the lumbar spine (P=0.02).
Pamidronate prevents bone loss in the hip and lumbar spine in men receiving treatment for prostate cancer with a gonadotropin-releasing hormone agonist.
促性腺激素释放激素激动剂治疗会降低前列腺癌男性的骨矿物质密度并增加骨折风险。我们进行了一项关于接受促性腺激素释放激素激动剂治疗的男性预防骨质疏松症的对照研究。
在一项为期48周的开放标签研究中，我们将47例患有晚期或复发性前列腺癌且无骨转移的男性随机分配，使其单独接受亮丙瑞林治疗或接受亮丙瑞林与帕米膦酸盐联合治疗（每12周静脉注射60mg）。采用双能X线吸收法测量腰椎和股骨近端的骨矿物质密度。通过定量计算机断层扫描测量腰椎的小梁骨矿物质密度。41名男性完成了该研究。
单独接受亮丙瑞林治疗的男性中，腰椎的平均（±标准误）骨矿物质密度下降了3.3±0.7%，转子处下降了2.1±0.6%，全髋下降了1.8±0.4%，腰椎的平均小梁骨矿物质密度下降了8.5±1.8%（与基线值相比，每次比较P<0.001）。相比之下，接受亮丙瑞林和帕米膦酸盐联合治疗的男性在任何骨骼部位的平均骨矿物质密度均无显著变化。两组在48周时腰椎（P<0.001）、转子（P = 0.003）、全髋（P = 0.005）和腰椎小梁骨（P = 0.02）的骨矿物质密度平均变化存在显著差异。
帕米膦酸盐可预防接受促性腺激素释放激素激动剂治疗前列腺癌的男性髋部和腰椎的骨质流失。
