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唑来膦酸预防前列腺癌雄激素剥夺治疗骨质疏松患者骨丢失的频率。

Frequency of zoledronic acid to prevent further bone loss in osteoporotic patients undergoing androgen deprivation therapy for prostate cancer.

机构信息

Department of Urology, Wirral University Teaching Hospitals, Wirral, UK.

出版信息

BJU Int. 2010 Apr;105(8):1082-8. doi: 10.1111/j.1464-410X.2009.08956.x. Epub 2009 Nov 13.

Abstract

OBJECTIVE

To evaluate the efficacy of zoledronic acid (ZA) in osteoporotic patients with prostate cancer receiving either luteinizing hormone-releasing hormone agonists (LHRHA, which accelerate bone loss) or bicalutamide (which preserves bone mineral density, BMD) as androgen-deprivation therapy is the mainstay of treatment for advanced prostate cancer, and many patients are osteoporotic at presentation, with others becoming so on treatment.

PATIENTS AND METHODS

Fifty-eight osteoporotic men with non-metastatic prostate cancer were followed for 3 years. Patients were randomly assigned to receive either LHRHA (29) or bicalutamide (29). All received 4 mg ZA 3-monthly for 1 year. BMD was measured by dual energy X-ray absorptiometry at four times: 1 year before ZA; immediately before ZA; after five infusions; and 1 year afterwards. Bone turnover markers (BTMs) were measured at 3-monthly intervals on ZA and 1 year later. All patients had radiography of the thoracolumbar spine at baseline and after ZA.

RESULTS

Patients on LHRHA showed a 4.9% decrease in BMD before ZA, a 1.6% increase after ZA and a 3.0% decrease 1 year later, compared to 2.0% increase, 7.8% increase and 1.9% decrease, respectively, in those on bicalutamide. BTMs decreased significantly after ZA. Seven patients (12%) had vertebral fractures at baseline, with none deteriorating at 1 year; two (3.5%) developed mandibular osteonecrosis.

CONCLUSION

Before ZA, BMD decreased on LHRHA, but was maintained on bicalutamide. Treatment with 3-monthly ZA increased BMD and suppressed BTMs in osteoporotic patients both on LHRHA and bicalutamide, but to a greater extent in the latter. However, 1 year after the last infusion, BMD declined, suggesting that annual administration is inadequate in these patients. The optimum frequency might be related to BMD at time of bisphosphonate initiation.

摘要

目的

评估唑来膦酸(ZA)在接受促黄体生成素释放激素激动剂(LHRHA,可加速骨质流失)或比卡鲁胺(可维持骨矿物质密度,BMD)作为雄激素剥夺治疗的前列腺癌骨质疏松患者中的疗效。对于晚期前列腺癌患者,LHRHA 是主要的治疗方法,许多患者在就诊时就已经患有骨质疏松症,还有一些患者在治疗过程中会出现骨质疏松症。

方法

对 58 名患有非转移性前列腺癌的骨质疏松症男性患者进行了 3 年的随访。患者被随机分配接受 LHRHA(29 名)或比卡鲁胺(29 名)治疗。所有患者均接受了为期 1 年的 ZA 治疗,每 3 个月给药 1 次,共 4 次。在 ZA 治疗前 1 年、开始 ZA 治疗前、接受 5 次输注后和 1 年后 4 次测量双能 X 线吸收仪(DXA)测量 BMD。在 ZA 治疗期间和 1 年后每 3 个月测量骨转换标志物(BTMs)。所有患者在基线和 ZA 治疗后均进行了胸腰椎射线照相。

结果

在接受 LHRHA 治疗的患者中,在开始 ZA 治疗前,BMD 下降了 4.9%,在开始 ZA 治疗后增加了 1.6%,1 年后下降了 3.0%,而接受比卡鲁胺治疗的患者分别增加了 2.0%、7.8%和 1.9%。ZA 治疗后 BTMs 显著下降。基线时有 7 名患者(12%)出现了椎体骨折,1 年后无恶化病例;有 2 名患者(3.5%)出现了下颌骨坏死。

结论

在开始 ZA 治疗前,LHRHA 治疗可导致 BMD 下降,但比卡鲁胺治疗可维持 BMD。在接受 LHRHA 和比卡鲁胺治疗的骨质疏松症患者中,每 3 个月接受 ZA 治疗可增加 BMD 和抑制 BTMs,但在后者中效果更为显著。然而,在最后一次输注后的 1 年内,BMD 下降,表明这些患者每年接受一次治疗是不够的。最佳的治疗频率可能与开始使用双膦酸盐时的 BMD 有关。

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