Department of Urology, Wirral University Teaching Hospitals, Wirral, UK.
BJU Int. 2010 Apr;105(8):1082-8. doi: 10.1111/j.1464-410X.2009.08956.x. Epub 2009 Nov 13.
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.
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.
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.
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.
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。
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。
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。
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。