Maintaining bone health during hormonal therapy for prostate cancer
A partir d'une revue systématique de la littérature (30 articles), cette méta-analyse évalue l'efficacité des traitements et des interventions permettant de préserver la santé osseuse et de prévenir le risque de fractures chez des patients atteints d'un cancer de la prostate non métastatique recevant une thérapie anti-androgénique
The prostate cancer disease continuum can be divided into states categorized by the status of the primary tumor (treated or untreated), the presence or absence of metastatic disease, and the serum level of testosterone. Each state includes patients with a range of prognoses, some of whom require immediate treatment. The competing risks from disease manifestations currently present or anticipated in the near term relative to comorbidities and life expectancy guide treatment decisions. For patients with metastatic disease or earlier-state aggressive tumors (for example, high-risk localized tumors) that are predicted to cause morbidity or shorten life expectancy, androgen deprivation therapy (ADT) is the first-line standard of care and has been the mainstay of treatment for more than 7 decades. Adverse effects include hot flashes, loss of libido, weakness, fatigue, change in personality, decreased mental acuity, metabolic syndrome, reduction in lean body mass, bone loss, and fragility fractures. The bone effects are the focus of Alibhai and colleagues' systematic review and meta-analysis (1). The review includes studies of men without metastatic prostate cancer receiving ADT. For these patients, bone loss and fracture risk increase over time as a result of depletion of testosterone and estradiol from ADT (2). Sarcopenia further increases fracture risk in the setting of low bone mineral density (BMD) and high risk for falls
Annals of Internal Medicine , éditorial, 2016