Greenspan Susan L
University of Pittsburgh School of Medicine, Clinical and Translational Research Center, Osteoporosis Prevention and Treatment Center, 3471 Fifth Avenue, Pittsburgh, Pennsylvania 15213, USA.
J Clin Endocrinol Metab. 2008 Jan;93(1):2-7. doi: 10.1210/jc.2007-1402.
Prostate cancer is the most common visceral malignancy in men. Androgen deprivation therapy (ADT) is commonly used in patients with nonmetastatic prostate cancer and is associated with significant bone loss and fractures. The greatest bone loss occurs during initiation of ADT. Men should have assessment of skeletal integrity with bone mineral density examination by dual x-ray absorptiometry of the hip and spine. Men with fragility fractures or osteoporosis by bone density should be considered for bisphosphonate therapy. Men with low bone mass may need antiresorptive therapy, depending on other risk factors. Men with a normal bone mineral density should be followed up closely with bone densitometry while on ADT. All men should receive preventive measures with calcium (1200 mg daily in divided doses), vitamin D (800-1000 IU/d), and weight-bearing exercise. Men should be evaluated for additional secondary causes of bone loss including vitamin D insufficiency. Guidelines are needed for androgen-induced bone loss screening and treatment.
前列腺癌是男性最常见的内脏恶性肿瘤。雄激素剥夺疗法（ADT）常用于非转移性前列腺癌患者，且与显著的骨质流失和骨折相关。最大程度的骨质流失发生在ADT开始时。男性应通过双能X线吸收法对髋部和脊柱进行骨密度检查，以评估骨骼完整性。骨密度显示有脆性骨折或骨质疏松的男性应考虑接受双膦酸盐治疗。骨量低的男性可能需要抗吸收治疗，具体取决于其他风险因素。骨密度正常的男性在接受ADT期间应密切进行骨密度测定随访。所有男性都应采取预防措施，补充钙（每日1200毫克，分剂量服用）、维生素D（800 - 1000国际单位/天），并进行负重锻炼。男性应评估是否存在包括维生素D不足在内的其他骨质流失继发原因。需要制定雄激素诱导性骨质流失筛查和治疗的指南。
