男性雄激素剥夺治疗前列腺癌时预防骨质疏松症：系统评价和荟萃分析。

Preventing Osteoporosis in Men Taking Androgen Deprivation Therapy for Prostate Cancer: A Systematic Review and Meta-Analysis.

机构信息

University of Sydney, Sydney, Australia.

Discipline of Surgery, University of Sydney, Sydney, Australia.

出版信息

Eur Urol Oncol. 2019 Sep;2(5):551-561. doi: 10.1016/j.euo.2018.11.001. Epub 2018 Nov 24.

DOI:10.1016/j.euo.2018.11.001

PMID:31411986

Abstract

CONTEXT

Advanced prostate cancer (PCa) is treated with androgen deprivation therapy (ADT) which results in loss of bone mineral density (BMD) and osteoporosis.

OBJECTIVE

To perform a systematic review and meta-analysis of evidence to determine the most effective methods of preventing BMD loss in patients with PCa treated with ADT.

EVIDENCE ACQUISITION

A systematic search of the Medline, Embase, and EBM Reviews databases was conducted on July 20, 2016 to identify studies on men who received an intervention to prevent osteoporosis after diagnosis of PCa and treatment with ADT. The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed and the studies found were critically appraised.

EVIDENCE SYNTHESIS

Twenty-five studies were included in the review and 13 had quantitative data sufficient for meta-analysis of BMD loss. Bisphosphonates led to a significant improvement in areas assessed: the mean difference was 7.09% (95% confidence interval [CI] 5.05-9.13%; p<0.00001) for lumbar BMD, 4.63% (95% CI 0.87-8.4; p=0.02) for femoral neck BMD, and 3.16% (95% CI 0.09-6.23%; p=0.04) for total hip BMD. Selective estrogen receptor modulators (SERMs) were less effective, exercise studies had inconsistent effects, and denosumab could not be quantitatively analyzed.

CONCLUSIONS

Bisphosphonates and denosumab are effective treatments in preventing BMD loss in men with PCa taking ADT. SERMs are a less effective alternative. Exercise programs are insufficient in isolation but have a role as an adjunct for holistic care.

PATIENT SUMMARY

In this review we determined the best option for preventing osteoporosis in men with prostate cancer being treated with androgen deprivation therapy. We found that bisphosphonates, denosumab, and selective estrogen receptor modulators (SERMs) were effective, but exercise was not useful in isolation. We conclude that bisphosphonates, denosumab, or SERMs should be used and exercise encouraged.

摘要

背景

晚期前列腺癌（PCa）采用雄激素剥夺疗法（ADT）进行治疗，该疗法会导致骨密度（BMD）丢失和骨质疏松症。

目的

系统回顾和荟萃分析证据，以确定预防接受 ADT 治疗的 PCa 患者 BMD 丢失的最有效方法。

证据获取

2016 年 7 月 20 日，对 Medline、Embase 和 EBM Reviews 数据库进行了系统搜索，以确定在诊断为 PCa 并接受 ADT 治疗后接受预防骨质疏松症干预的男性的研究。研究遵循了系统评价和荟萃分析的首选报告项目，并对发现的研究进行了严格评估。

证据综合

综述纳入了 25 项研究，其中 13 项有足够的定量数据进行 BMD 丢失的荟萃分析。双膦酸盐可显著改善以下评估部位：腰椎 BMD 的平均差异为 7.09%（95%置信区间 [CI] 5.05-9.13%；p<0.00001），股骨颈 BMD 为 4.63%（95% CI 0.87-8.4；p=0.02），全髋关节 BMD 为 3.16%（95% CI 0.09-6.23%；p=0.04）。选择性雌激素受体调节剂（SERMs）效果较差，运动研究效果不一致，而地舒单抗无法进行定量分析。