ADT for prostate cancer with little threat to bone density with supplements

Despite a slight decrease in bone mineral density (BMD) in patients with localized high-risk prostate cancer receiving long-term androgen deprivation therapy (ADT), analysis of men enrolled in the phase showed little change to clinical BMD status There wasn’t. Ⅲ Trial.

After 30 months of follow-up, no patients changed from normal baseline BMD to osteoporosis, and no patients had vulnerable fractures, MDCN physicians at the Jewish General Hospital in Montreal said. reported.

“Therefore, for most patients with localized prostate cancer who are receiving long-term androgen depletion therapy, calcium and vitamin D supplementation may be sufficient,” they wrote in the paper. Urology Journal..

Long-term ADT in combination with radiation therapy has been shown to improve progression-free survival, disease-free survival, and overall survival in patients with localized high-risk prostate cancer. However, ADT is also associated with a reduction in BMD beyond that seen with normal aging, increasing the risk of osteoporosis and fractures. Therefore, calcium and vitamin D supplements are recommended for patients undergoing long-term ADT with or without bone modifiers.

Niazi and his colleagues pointed out that there are many trials comparing calcium / vitamin D supplementation with the presence or absence of bone modifiers. These show that supplements in combination with bone modifiers reduce BMD loss, but few studies have shown a reduction in fracture rates.

“Changes in BMD will have clinical significance only if they result in increased osteoporosis and clinical fractures,” the authors write. In this study, their purpose was to extract data from. Was to quantify changes in BMD based on. Prostate Cancer Study 5 (PCS-V), Designed to compare conventional radiation therapy with fractionated radiation therapy.

A total of 329 patients were enrolled in PCS-V. Only those who underwent dual-energy X-ray absorption measurement scans to assess BMD were included in this study, with 226, 231, and 173 patients with lumbar, femoral neck, and total femoral BMD, respectively. It was measured. Patients received a luteinizing hormone-releasing hormone agonist for 28 months, along with calcium and vitamin D supplementation.

The average rate of change in BMD at follow-up was -2.65% for the lumbar spine, -2.76% for the neck of the femur, and -4.27% for the total femoral BMD. According to Niazi and his colleagues, most changes were clinically meaningless, with 79% of men remaining in the normal BMD category.

Note that BMD measurements in the proximal femur are the best predictors of fracture risk, and the authors found no clinical change in BMD status from normal to osteoporosis after ADT in patients 83. We found that% maintained a normal proximal femoral BMD. Changes from normal to bone loss and from bone loss to osteoporosis were seen in 11% and 5% of patients, respectively.

Only two patients suffered fractures, both traumatic. One closed the garage door 16 months after the start of hormone therapy and the other was traumatized 14 months after the start of ADT. Fractures of the ribs. Both of these patients suffered from baseline bone loss and remained in that category after ADT.

Niazi and his colleagues found that the “lack of significant changes” in BMD and fracture risk was the added value of bone modifiers in patients with localized high-risk prostate cancer who received ADT and were supplemented with calcium and vitamin D. Suggested to challenge.

“Denosumab [Xgeva] Radiation-induced spinal fractures can be reduced by 2%, which must be balanced with cost-effectiveness.

In addition to calcium and vitamin D, researchers suggest that further research is needed to determine which patients will benefit most from bone modifiers.