Cianferotti Luisella, Bertoldo Francesco, Carini Marco, Kanis John A, Lapini Alberto, Longo Nicola, Martorana Giuseppe, Mirone Vincenzo, Reginster Jean-Yves, Rizzoli Rene, Brandi Maria Luisa
Department of Surgery and Translational Medicine, University of Florence, University Hospital of Florence, Florence, Italy.
Department of Medicine, University of Verona, Verona, Italy.
Oncotarget. 2017 May 18;8(43):75646-75663. doi: 10.18632/oncotarget.17980. eCollection 2017 Sep 26.
Androgen deprivation therapy is commonly employed for the treatment of non-metastatic prostate cancer as primary or adjuvant treatment. The skeleton is greatly compromised in men with prostate cancer during androgen deprivation therapy because of the lack of androgens and estrogens, which are trophic factors for bone. Men receiving androgen deprivation therapy sustain variable degrees of bone loss with an increased risk of fragility fractures. Several bone antiresorptive agents have been tested in randomized controlled trials in these patients. Oral bisphosphonates, such as alendronate and risedronate, and intravenous bisphosphonates, such as pamidronate and zoledronic acid, have been shown to increase bone density and decrease the risk of fractures in men receiving androgen deprivation therapy. Denosumab, a fully monoclonal antibody that inhibits osteoclastic-mediated bone resorption, is also effective in increasing bone mineral density and reducing fracture rates in these patients. The assessment of fracture risk, T-score and/or the evaluation of prevalent fragility fractures are mandatory for the selection of patients who will benefit from antiresorptive therapy. In the future, new agents modulating bone turnover and skeletal muscle metabolism will be available for testing in these subjects.
雄激素剥夺疗法通常作为主要或辅助治疗用于非转移性前列腺癌的治疗。在雄激素剥夺治疗期间，前列腺癌男性的骨骼会因缺乏雄激素和雌激素而受到严重损害，而雄激素和雌激素是骨骼的营养因子。接受雄激素剥夺治疗的男性会出现不同程度的骨质流失，脆性骨折风险增加。在这些患者中，几种骨吸收抑制剂已在随机对照试验中进行了测试。口服双膦酸盐，如阿仑膦酸钠和利塞膦酸钠，以及静脉注射双膦酸盐，如帕米膦酸二钠和唑来膦酸，已被证明可提高接受雄激素剥夺治疗男性的骨密度并降低骨折风险。地诺单抗是一种抑制破骨细胞介导的骨吸收的全人源单克隆抗体，在这些患者中增加骨矿物质密度和降低骨折率方面也有效。对于选择将从抗吸收治疗中获益的患者，骨折风险评估、T值和/或对现患脆性骨折的评估是必不可少的。未来，调节骨转换和骨骼肌代谢的新型药物将可用于在这些受试者中进行测试。
