Institute of Endocrine and Metabolic Sciences, San Raffaele Vita Salute University, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Hospital, Milan, Italy.
Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy.
Trends Endocrinol Metab. 2021 Mar;32(3):135-158. doi: 10.1016/j.tem.2020.12.004. Epub 2021 Jan 26.
Medical treatment of prostate cancer (PC) is multidisciplinary, resulting in prolonged survival. Androgen-deprivation therapy (ADT) can have negative effects on skeletal metabolism, particularly if combined with glucocorticoids. We discuss the pathophysiology and effects of ADT and glucocorticoids on skeletal endpoints, as well as the awareness and management of bone fragility. Coadministration of glucocorticoids is necessary with abiraterone because this causes a novel acquired form of 17-hydroxylase deficiency and synergistically increases the risk of fracture by affecting bone quality. Bone antiresorptive agents [selective estrogen receptor modulators (SERMS), bisphosphonates, and denosumab] increase bone mineral density (BMD) and in some instances reduce fracture risk in PC patients on ADT. Awareness and management of bone health in PC can be improved by integrating endocrinologists into the multidisciplinary PC team.
前列腺癌（PC）的治疗是多学科的，这导致患者的生存时间延长。去势治疗（ADT）会对骨骼代谢产生负面影响，尤其是与糖皮质激素联合使用时。我们讨论了 ADT 和糖皮质激素对骨骼终点的病理生理学和影响，以及对骨脆弱性的认识和管理。因为阿比特龙会导致一种新的获得性 17-羟化酶缺乏，并且通过影响骨质量协同增加骨折风险，所以必须与糖皮质激素联合使用。骨抗吸收剂[选择性雌激素受体调节剂（SERMS）、双膦酸盐和地舒单抗]可增加骨密度（BMD），并在某些情况下降低接受 ADT 的 PC 患者的骨折风险。通过将内分泌学家纳入多学科 PC 团队，可以提高对 PC 患者骨骼健康的认识和管理。
