唑来膦酸治疗骨质疏松的非转移性去势敏感性前列腺癌患者骨密度和新发椎体骨折的影响。
Effects of once-yearly zoledronic acid on bone density and incident vertebral fractures in nonmetastatic castration-sensitive prostate cancer patients with osteoporosis.
机构信息
Department of Palliative Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Urology, Koto Hospital, Tokyo, Japan.
出版信息
BMC Cancer. 2021 Apr 17;21(1):422. doi: 10.1186/s12885-021-08177-w.
BACKGROUND
Androgen deprivation therapy (ADT) is the effective treating prostate cancer but is often accompanied by cancer treatment-induced bone loss (CTIBL), which impairs the patient's quality of life. In patients with nonmetastatic castration-sensitive prostate cancer (M0CSPC) who already have osteoporosis before starting ADT, appropriate bone-modifying agent intervention must be performed in parallel, as the patient has a high risk of future fracture. However, little is known about therapeutic interventions aimed at preventing the progression of CTIBL and new fractures. The present study explored the effect of once-yearly zoledronic acid 5 mg (ZOL 5 mg) on bone mineral density (BMD) and new vertebral fractures (VFs) in M0CSPC patients with coexisting osteoporosis before starting ADT.
METHODS
We conducted a retrospective, multi-institutional, cohort study involving 42 M0CSPC patients with osteoporosis who had undergone ADT with/without a single intravenous infusion of ZOL 5 mg at the start of ADT (ZOL 5 mg group, n = 26; control group, n = 16). The association of the ZOL 5 mg with changes in the BMD from baseline to 12 months and the incidence of VFs were evaluated.
RESULTS
Prevalent VFs were found in 47.6% of all patients at baseline. ZOL 5 mg significantly increased the lumbar spine BMD (LS-BMD) (mean rate of change: + 4.02%, p < 0.0001) and significantly decreased the TRACP-5b (mean rate of change: - 52.1%, p < 0.0001) at 12 months after starting ADT. Incident VFs were identified in 19.0% of all patients at 12 months after starting ADT. After adjusting for the age, BMI, and changes in the LS-BMD, ZOL 5 mg was not significantly associated with incident VFs (odds ratio 0.66, 95% confidence interval 0.04-11.3, p = 0.7774).
CONCLUSION
ZOL 5 mg significantly increased the LS-BMD 12 months after starting ADT, and our short-term results showed that ZOL 5 mg was not significantly correlated with the suppression of incident vertebral fractures.
背景
雄激素剥夺疗法（ADT）是治疗前列腺癌的有效方法，但常伴随着癌症治疗引起的骨丢失（CTIBL），这会降低患者的生活质量。对于已经患有骨质疏松症且正在接受 ADT 的非转移性去势敏感型前列腺癌（M0CSPC）患者，必须同时进行适当的骨修饰剂干预，因为患者未来发生骨折的风险很高。然而，目前对于预防 CTIBL 进展和新发骨折的治疗干预措施知之甚少。本研究探讨了在开始 ADT 之前患有骨质疏松症的 M0CSPC 患者中，每年一次给予唑来膦酸 5mg（ZOL 5mg）对骨密度（BMD）和新发椎体骨折（VF）的影响。
方法
我们进行了一项回顾性、多机构队列研究，共纳入 42 例在开始 ADT 时接受 ADT 联合/不联合单次静脉注射唑来膦酸 5mg（ZOL 5mg 组，n=26；对照组，n=16）的 M0CSPC 合并骨质疏松症患者。评估了 ZOL 5mg 对基线至 12 个月时 BMD 变化的影响，以及 VF 的发生率。
结果
所有患者基线时均存在现患性 VF，占 47.6%。ZOL 5mg 可显著增加腰椎骨密度（LS-BMD）（平均变化率：+4.02%，p<0.0001），并显著降低 TRACP-5b（平均变化率：-52.1%，p<0.0001）在开始 ADT 后 12 个月时。在开始 ADT 后 12 个月时，所有患者中有 19.0%发生新发 VF。在调整年龄、BMI 和 LS-BMD 变化后，ZOL 5mg 与新发 VF 无显著相关性（比值比 0.66，95%置信区间 0.04-11.3，p=0.7774）。
结论
ZOL 5mg 可显著增加开始 ADT 后 12 个月时的 LS-BMD，我们的短期结果显示，ZOL 5mg 与抑制新发椎体骨折无显著相关性。
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