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Bone
mineral density changes in prostate cancer patients on androgen
deprivation therapy
The
objective of our study was to characterize bone mineral density changes in
prostate cancer patients on androgen deprivation therapy (ADT) during the
first two years of uninterrupted therapy. Moreover we tried to identify
which location best reflects bone mass loss.
Using
dual energy x-ray absorptiometry, bone mineral density was prospectively
assessed in non metastatic prostate cancer patients, at the lumbar spine
and femoral neck, Ward´s triangle, trochanter and total hip. Measurements
were performed at baseline and yearly thereafter in ADT patients and at
baseline and 1 year in controls (age-matched prostate cancer patients,
free of biochemical progression after radical prostatectomy). A group of
61 patients were included; 31 in each group. Median age (70 and 69y.
respectively), mean Gleason score and mean baseline serum testosterone did
not significantly differ. Patients
under ADT experienced a significant bone mass loss at 12m in all locations,
ranging from 2.29% to 5.55% (p<0.001). In contrast, bone mineral
density did not change significantly (0.64% to 1.68%) in non ADT patients.
In the 20 ADT patients followed during 24m, second year decrease was not
as severe, nor was significant when compared to the first year values.
Ward´s triangle was the location that reflected the major bone mass loss,
with decreases reaching a 5.55% at 12m and 7.05% at 24m. We concluded that bone mineral density decreases during the first 24 months of androgen suppression with the most relevant effect during the first year. Wards’ triangle is the axial skeletal site that reflects the major bone mass loss. Because, the deleterious impact of long term androgen suppression in bone mineral density is inversely related to fracture risk and indirectly to survival in prostate cancer patients, early diagnosis and prevention of bone mass loss is warranted in these patients.
Bibliographical reference:
Juan Morote Department of Urology, Vall d'Hebron Hospital, Autonoma University School of Medicine, Barcelona, Spain
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