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首页> 外文期刊>Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research >Differing Effects of Zoledronic Acid on Bone Microarchitecture and Bone Mineral Density in Men Receiving Androgen Deprivation Therapy: A Randomized Controlled Trial
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Differing Effects of Zoledronic Acid on Bone Microarchitecture and Bone Mineral Density in Men Receiving Androgen Deprivation Therapy: A Randomized Controlled Trial

机译：唑代酸对接受雄激素剥夺治疗的男性骨微体系结构和骨密度的不同作用：随机对照试验

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Androgen deprivation therapy (ADT) given to men with prostate cancer causes rapid and severe sex steroid deficiency, leading to increased bone remodeling and accelerated bone loss. To examine the effects of a single dose of zoledronic acid on bone microarchitecture, we conducted a 2-year randomized placebo controlled trial in 76 men, mean age (interquartile range [IQR]) 67.8 years (63.8 to 73.9) with non-metastatic prostate cancer commencing adjuvant ADT; 39 were randomized to zoledronic acid and 37 to matching placebo. Bone microarchitecture was measured using high-resolution peripheral quantitative computed tomography (HR-pQCT). Using a mixed model, mean adjusted differences (MAD; 95% confidence interval [95% CI]) between the groups are reported as the treatment effect at several time points. Over 24 months, zoledronic acid showed no appreciable treatment effect on the primary outcomes for total volumetric bone mineral density (vBMD); radius (6.7 mg HA/cm(3)[-2.0 to 15.4],p= 0.21) and tibia (1.9 mg HA/cm(3)[-3.3 to 7.0],p= 0.87). Similarly, there were no between-group differences in other measures of microarchitecture, with the exception of a modest effect of zoledronic acid over placebo in total cortical vBMD at the radius over 12 months (17.3 mgHA/cm(3)[5.1 to 29.5]). In contrast, zoledronic acid showed a treatment effect over 24 months on areal bone mineral density (aBMD) by dual-energy X-ray absorptiometry (DXA) at all sites, including lumbar spine (0.10 g/cm(2)[0.07 to 0.13]),p < 0.001), and total hip (0.04 g/cm(2)[0.03 to 0.05],p < 0.001). Bone remodeling markers were initially suppressed in the treatment group then increased but remained lower relative to placebo (MADs at 24 months CTX -176 ng/L [-275 to -76],p < 0.001; P1NP -18 mg/L [-32 to -5],p < 0.001). These findings suggest that a single dose of zoledronic acid over 2 years is ineffective in preventing the unbalanced bone remodeling and severe microstructural deterioration associated with ADT therapy. (c) 2020 American Society for Bone and Mineral Research.
机译：男性前列腺癌患者接受雄激素剥夺疗法（ADT）会导致快速而严重的性类固醇缺乏，导致骨重塑增加和骨丢失加速。为了研究单剂量唑来膦酸对骨微结构的影响，我们对76名男性进行了一项为期2年的随机安慰剂对照试验，他们的平均年龄（四分位区间[IQR]）为67.8岁（63.8至73.9），非转移性前列腺癌患者开始辅助ADT；39人随机分为唑来膦酸组，37人随机分为安慰剂组。使用高分辨率外周定量计算机断层扫描（HR-pQCT）测量骨微结构。使用混合模型，将两组之间的平均校正差异（MAD；95%置信区间[95%CI]）报告为几个时间点的治疗效果。24个月后，唑来膦酸对总体积骨密度（vBMD）的主要转归没有明显的治疗效果；桡骨（6.7毫克公顷/厘米（3）[-2.0至15.4]，p=0.21）和胫骨（1.9毫克公顷/厘米（3）[-3.3至7.0]，p=0.87）。类似地，除了唑来膦酸在12个月内对桡骨总皮质vBMD（17.3 mgHA/cm（3）[5.1至29.5]）的适度影响外，其他微结构指标在组间没有差异。相比之下，唑来膦酸在24个月内通过双能X射线骨密度仪（DXA）对所有部位的面积骨密度（aBMD）显示出治疗效果，包括腰椎（0.10 g/cm（2）[0.07至0.13]），p<0.001，以及全髋（0.04 g/cm（2）[0.03至0.05]，p<0.001）。治疗组的骨重塑标志物最初受到抑制，然后增加，但与安慰剂相比仍然较低（24个月时，CTX-176 ng/L[-275至-76]，p<0.001；P1NP-18 mg/L[-32至-5]，p<0.001）。这些发现表明，单剂量唑来膦酸在2年内对预防ADT治疗相关的不平衡骨重塑和严重的微结构恶化无效。（c） 2020年美国骨与矿物研究学会。

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