Satoh Takefumi, Kimura Masaki, Matsumoto Kazumasa, Tabata Ken-ichi, Okusa Hiroshi, Bessho Hideharu, Iwamura Masatsugu, Ishiyama Hiromichi, Hayakawa Kazushige, Baba Shiro
Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan.
Cancer. 2009 Aug 1;115(15):3468-74. doi: 10.1002/cncr.24404.
Androgen-deprivation therapy (ADT) decreases bone mineral density (BMD) and increases fracture risk in patients with prostate carcinoma. The authors investigated the effectiveness of a single infusion of zoledronic acid initiated subsequent to ADT on BMD with hormone-naive prostate carcinoma.
Forty men received either a single infusion of zoledronic acid (4 mg intravenously on Day 1) or no infusion during ADT. BMD of the proximal femur and posteroanterior lumbar spine was measured by dual-energy x-ray absorptiometry and urinary N-telopeptide (u-NTx) at 6 and 12 months.
At baseline, the overall BMDs demonstrated no significant difference in lumbar spine and hip regions. At 6 months, mean (+/-standard error) BMD of the posteroanterior lumbar spine decreased 4.6%+/-1.0% in control patients and increased 5.1%+/-1.2% in patients receiving zoledronic acid, a significant difference (P=.0002). At 12 months, the change in BMD between the 2 groups was statistically significantly different at the lumbar region (P=.0004), indicating that zoledronate preserved BMD. For u-NTx, bone turnover was statistically significantly decreased in the zoledronate group compared with controls at 6 months (P<.0001), but returned to pretreatment levels at 12 months in the zoledronate group.
Bone loss begins at 6 months with ADT. A single infusion of zoledronic acid in patients receiving ADT reduces bone mineral loss and maintains BMD at least at 12 months during ADT. Further study is needed to determine the best dosing schedule to prevent ADT-induced bone loss in men with hormone-naive prostate carcinoma.
雄激素剥夺疗法（ADT）会降低前列腺癌患者的骨矿物质密度（BMD）并增加骨折风险。作者研究了在ADT之后单次输注唑来膦酸对未经激素治疗的前列腺癌患者骨密度的有效性。
40名男性在ADT期间接受了单次唑来膦酸输注（第1天静脉注射4毫克）或未接受输注。在6个月和12个月时，通过双能X线吸收法测量股骨近端和腰椎前后位的骨密度以及尿N-端肽（u-NTx）。
基线时，腰椎和髋部区域的总体骨密度无显著差异。6个月时，对照组患者腰椎前后位的平均（±标准误差）骨密度下降了4.6%±1.0%，而接受唑来膦酸治疗的患者骨密度增加了5.1%±1.2%，差异有统计学意义（P = 0.0002）。12个月时，两组在腰椎区域的骨密度变化有统计学显著差异（P = 0.0004），表明唑来膦酸盐可保留骨密度。对于u-NTx，唑来膦酸盐组在6个月时骨转换与对照组相比有统计学显著降低（P < 0.0001），但在12个月时唑来膦酸盐组恢复到治疗前水平。
ADT在6个月时开始导致骨质流失。接受ADT的患者单次输注唑来膦酸可减少骨矿物质流失，并在ADT期间至少维持12个月的骨密度。需要进一步研究以确定预防未经激素治疗的前列腺癌男性ADT引起的骨质流失的最佳给药方案。
