Panju Abbas H, Breunis Henriette, Cheung Angela M, Leach Marc, Fleshner Neil, Warde Padraig, Duff-Canning Sarah, Krahn Murray, Naglie Gary, Tannock Ian, Tomlinson George, Alibhai Shabbir M H
Department of Medicine, University Health Network, Toronto, Ontario, Canada.
BJU Int. 2009 Mar;103(6):753-7. doi: 10.1111/j.1464-410X.2008.08156.x. Epub 2008 Oct 24.
To determine whether clinicians discuss bone-specific side-effects with patients on androgen-deprivation therapy (ADT) for prostate cancer, or prescribe lifestyle and pharmacological interventions for low bone mineral density (BMD), as decreased BMD is a common side-effect of ADT, leading to increased risk of fracture.
Sixty-six men (mean age 70.6 years) with non-metastatic prostate cancer and starting continuous ADT were enrolled in a prospective longitudinal study. BMD was determined by dual X-ray absorptiometry (DXA) at baseline. Patients were interviewed to obtain their medical histories, and charts were reviewed to determine whether clinicians documented potential bone side-effects in clinic notes, and made lifestyle and/or medication recommendations. Both were done at the start of ADT, and 3 and 6 months later. Patients were classified based on DXA T-score as having normal BMD, as osteopenic, or osteoporotic.
At baseline, 53% of patients had osteopenia and 5% had osteoporosis. Within 6 months of starting ADT, general side-effects and bone-specific side-effects of ADT were documented as being discussed with 26% and 15%, respectively. Clinicians recommended lifestyle interventions to 11% of patients. Pharmacological interventions (calcium, vitamin D, and/or bisphosphonates) were recommended to 18% of all patients within 6 months of starting ADT, and to 26% and 67% of osteopenic and osteoporotic patients, respectively.
A minority of patients is being informed of bone-specific side-effects of ADT. Lifestyle and drug interventions to prevent declines in BMD were recommended uncommonly. Practices around bone health for men starting ADT are suboptimal.
确定临床医生是否会与接受雄激素剥夺疗法（ADT）治疗前列腺癌的患者讨论骨骼特异性副作用，或者是否会针对低骨密度（BMD）开具生活方式和药物干预措施，因为BMD降低是ADT的常见副作用，会导致骨折风险增加。
66名患有非转移性前列腺癌且开始接受持续ADT治疗的男性（平均年龄70.6岁）被纳入一项前瞻性纵向研究。在基线时通过双能X线吸收法（DXA）测定骨密度。对患者进行访谈以获取他们的病史，并查阅病历以确定临床医生是否在临床记录中记录了潜在的骨骼副作用，并给出生活方式和/或药物建议。这两项工作均在ADT开始时、3个月后和6个月后进行。根据DXA T评分将患者分类为骨密度正常、骨质减少或骨质疏松。
在基线时，53%的患者患有骨质减少，5%的患者患有骨质疏松。在开始ADT的6个月内，记录显示分别有26%和15%的患者讨论了ADT的一般副作用和骨骼特异性副作用。临床医生向11%的患者推荐了生活方式干预措施。在开始ADT的6个月内，向所有患者中的18%推荐了药物干预措施（钙、维生素D和/或双膦酸盐），向骨质减少和骨质疏松患者中分别有26%和67%的患者推荐了该措施。
少数患者被告知ADT的骨骼特异性副作用。预防骨密度下降的生活方式和药物干预措施很少被推荐。对于开始接受ADT治疗的男性，围绕骨骼健康的做法并不理想。
