Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden.
Department of Oncology, Skane University Hospital, Malmö and Lund, Sweden.
Andrology. 2017 Sep;5(5):898-904. doi: 10.1111/andr.12383. Epub 2017 Jun 7.
The cure rate of testicular cancer exceeds 95%, but testicular cancer survivors (TCS) are at increased risk of hypogonadism (HG). It has been suggested that TCS have reduced bone mineral density (BMD), but it is unclear whether this is related to HG or a direct effect of cancer therapy. The aim of this study was to evaluate whether TCS have decreased BMD, and if BMD is related to HG and/or the cancer treatment given. We investigated 91 TCS (mean age at diagnosis: 31 years; mean 9.3 years follow-up) and equal number of age matched controls (mean age at inclusion 40.3 years and 41.2 years, respectively). Total testosterone and LH were measured. BMD was determined using dual-energy X-ray absorptiometry (DXA). Low BMD (LBD) was defined as Z-score <-1. Compared to eugonadal TCS, both TCS with untreated HG (mean difference: -0.063 g/cm ; 95% CI: -0.122; -0.004 p = 0.037) and TCS receiving androgen replacement (mean difference -0.085 g/cm ; 95% CI: -0.168; -0.003; p = 0.043) presented with statistically significantly 6-8% lower hip BMD. At the spine, L1-L4, an 8% difference reached the level of statistical significance only for those with untreated HG (mean difference: -0.097 g/cm ; 95% CI: -0.179; -0.014; p = 0.022). TCS with untreated HG had significantly increased OR for spine L1-L4 LBD (OR = 4.1; 95% CI: 1.3; 13; p = 0.020). The associations between the treatment given and BMD were statistically non-significant, both with and without adjustment for HG. In conclusion, TCS with HG are at increased risk of impaired bone health. Prevention of osteoporosis should be considered as an important part in future follow up of these men.
睾丸癌的治愈率超过 95%，但睾丸癌幸存者（TCS）患性腺功能减退症（HG）的风险增加。有人认为 TCS 的骨密度（BMD）降低，但尚不清楚这是否与 HG 或癌症治疗直接相关。本研究旨在评估 TCS 是否存在 BMD 降低，以及 BMD 是否与 HG 和/或所给予的癌症治疗有关。我们调查了 91 名 TCS（诊断时的平均年龄为 31 岁；平均随访 9.3 年）和年龄匹配的对照组（平均纳入年龄分别为 40.3 岁和 41.2 岁）。测量总睾酮和 LH。使用双能 X 射线吸收法（DXA）测定 BMD。低 BMD（LBD）定义为 Z 分数 <-1。与性腺功能正常的 TCS 相比，未治疗的 HG 的 TCS（平均差异：-0.063 g/cm；95%CI：-0.122；-0.004 p=0.037）和接受雄激素替代治疗的 TCS（平均差异：-0.085 g/cm；95%CI：-0.168；-0.003；p=0.043）的髋部 BMD 分别低 6-8%，差异有统计学意义。在脊柱 L1-L4 处，仅对于未治疗的 HG 的 TCS，8%的差异达到统计学意义（平均差异：-0.097 g/cm；95%CI：-0.179；-0.014；p=0.022）。未治疗的 HG 的 TCS 脊柱 L1-L4 LBD 的 OR 值显著增加（OR=4.1；95%CI：1.3；13；p=0.020）。考虑到 HG，给予治疗与 BMD 之间的关联无统计学意义，无论是否调整 HG，结果均如此。总之，HG 的 TCS 存在骨健康受损的风险增加。在这些男性的后续随访中，应考虑预防骨质疏松症作为重要的一部分。
