Greenspan Susan L, Coates Penelope, Sereika Susan M, Nelson Joel B, Trump Donald L, Resnick Neil M
Osteoporosis Prevention and Treatment Center, University of Pittsburgh, Kaufmann Medical Building, Suite 1110, 3471 Fifth Avenue, Pittsburgh, Pennsylvania 15213-3221, USA.
J Clin Endocrinol Metab. 2005 Dec;90(12):6410-7. doi: 10.1210/jc.2005-0183. Epub 2005 Sep 27.
Although androgen deprivation therapy (ADT) for prostate cancer is associated with bone loss, little is known about when this bone loss occurs.
We postulated that men on ADT would experience the greatest bone loss acutely after initiation of ADT.
We conducted a 12-month prospective study at an academic medical center.
We studied 152 men with prostate cancer (30 with acute ADT, < 6 months; 50 with chronic ADT, > or = 6 months; and 72 with no ADT) and 43 healthy age-matched controls.
We assessed bone mineral density (BMD) of the hip, wrist, total body, and spine; body composition; and markers of bone turnover.
After 12 months, men receiving acute ADT had a significant reduction in BMD of 2.5 +/- 0.6% at the total hip, 2.4 +/- 1.0% at the trochanter, 2.6 +/- 0.5% at the total radius, 3.3 +/- 0.5% at the total body, and 4.0 +/- 1.5% at the posteroanterior spine (all P < 0.05). Men with chronic ADT had a 2.0 +/- 0.6% reduction in BMD at the total radius (P < 0.05). Healthy controls and men with prostate cancer not receiving ADT had no significant reduction in BMD. Both use and duration of ADT were associated with change in bone mass at the hip (P < 0.05). Men receiving acute ADT had a 10.4 +/- 1.7% increase in total body fat and a 3.5 +/- 0.5% reduction in total body lean mass at 12 months, whereas body composition did not change in men with prostate cancer on chronic ADT or in healthy controls (P < 0.05). Markers of bone formation and resorption were elevated in men receiving acute ADT after 6 and 12 months compared with the other men with prostate cancer and controls (P < 0.05). Men in the highest tertile of bone turnover markers at 6 months had the greatest loss of bone density at 12 months.
Men with prostate cancer who are initiating ADT have a 5- to 10-fold increased loss of bone density at multiple skeletal sites compared with either healthy controls or men with prostate cancer who are not on ADT, placing them at increased risk of fracture. Bone loss is maximal in the first year after initiation of ADT, suggesting initiation of early preventive therapy.
虽然前列腺癌的雄激素剥夺疗法（ADT）与骨质流失有关，但对于这种骨质流失何时发生却知之甚少。
我们推测接受ADT的男性在开始ADT后会急性经历最大程度的骨质流失。
我们在一家学术医疗中心进行了一项为期12个月的前瞻性研究。
我们研究了152名前列腺癌男性（30名接受急性ADT，<6个月；50名接受慢性ADT，≥6个月；72名未接受ADT）以及43名年龄匹配的健康对照者。
我们评估了髋部、腕部、全身和脊柱的骨矿物质密度（BMD）；身体成分；以及骨转换标志物。
12个月后，接受急性ADT的男性全髋部BMD显著降低2.5±0.6%，转子处降低2.4±1.0%，全桡骨降低2.6±0.5%，全身降低3.3±0.5%，后前位脊柱降低4.0±1.5%（所有P<0.05）。接受慢性ADT的男性全桡骨BMD降低2.0±0.6%（P<0.05）。健康对照者和未接受ADT的前列腺癌男性BMD无显著降低。ADT的使用和持续时间均与髋部骨量变化相关（P<0.05）。接受急性ADT的男性在12个月时全身脂肪增加10.4±1.7%，全身瘦体重减少3.5±0.5%，而接受慢性ADT的前列腺癌男性或健康对照者的身体成分没有变化（P<0.05）。与其他前列腺癌男性和对照者相比，接受急性ADT的男性在6个月和12个月后骨形成和骨吸收标志物升高（P<0.05）。6个月时骨转换标志物处于最高三分位数的男性在12个月时骨密度损失最大。
与健康对照者或未接受ADT的前列腺癌男性相比，开始接受ADT的前列腺癌男性在多个骨骼部位的骨密度损失增加5至10倍，使其骨折风险增加。骨质流失在开始ADT后的第一年最大，提示应开始早期预防性治疗。
