Androgen Deprivation Therapy Differentially Impacts Bone and Muscle in the Short Term in Physically Active Men With Prostate Cancer.
Androgen Deprivation Therapy Differentially Impacts Bone and Muscle in the Short Term in Physically Active Men With Prostate Cancer.
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作者：
Maalouf NM;Chhabra A;Zafereo J;Querry R;Towler DA;Thakur UJ;Frankl J;Poindexter JR;Mogharrabi B;Xac M;Öz OK;Rubin CD
雄激素剥夺治疗（ADT）是晚期前列腺癌（PCa）治疗的基石。它的使用与骨矿物质密度（BMD）的损失和更大的福尔斯和骨质疏松性骨折的风险有关。在这项前瞻性队列研究中，我们检查了ADT对开始ADT治疗PCa的男性肌肉和骨强度的影响。在三个时间点对参与者进行评估：ADT开始前（第0周）、ADT开始后6周和24周。研究测量包括空腹血液水平（用于肌肉和骨代谢活动的标志物），MRI和QCT成像（用于肌肉脂肪含量，骨密度和结构），以及肌肉力量和步态的有效临床测试。16名男性完成了所有研究访视。在基线和整个研究期间，参与者每周锻炼4次，但体重仍然增加（第24周与第0周相比增加2.0 kg，p = 0.004）。从生化方面来看，所有男性在ADT后性激素均持续早期和持续显著降低，沿着血清I型胶原C端肽进行性和显著增加（CTX，第24周与第0周相比+84%）。血清硬化蛋白（p = 0.09）和白细胞介素6（IL-6）（p = 0.08）有升高趋势，但血清肌肉生长抑制素无显著变化（p = 0.99）。通过QCT测量的股骨颈体积BMD显著下降（第24周与第0周相比为-3.7%），特别是在小梁室。在MRI上，大腿肌肉脂肪分数没有显著变化。在身体测试中，男性的握力较弱，但下肢和腰椎肌肉力量或步态功能测试没有恶化。总之，在体力活动男性中，ADT持续24周导致骨吸收显著增加和BMD降低，但大腿肌肉质量（成像）或力量和步态（功能测试）无显著变化。© 2021作者JBMR Plus由Wiley Periodicals LLC代表美国骨与矿物质研究学会出版。
Androgen deprivation therapy (ADT) is a cornerstone of advanced prostate cancer (PCa) therapy. Its use is associated with a loss of bone mineral density (BMD) and a greater risk of falls and osteoporotic fractures. In this prospective cohort study, we examined the impact of ADT on muscle and bone strength in men initiating ADT for PCa. Participants were evaluated at three time points: immediately before (week 0), and 6 and 24 weeks after ADT initiation. Study measures included fasting blood levels (for markers of muscle and bone metabolic activity), MRI and QCT imaging (for muscle fat content, and bone density and architecture), and validated clinical tests of muscle strength and gait. Sixteen men completed all study visits. At baseline and throughout the study, participants exercised a median of four times/week, but still experienced weight gain (+2.0 kg at week 24 versus week 0, p = 0.004). Biochemically, all men sustained dramatic early and persistent reductions in sex hormones post‐ADT, along with a progressive and significant increase in serum C‐telopeptide of type I collagen (CTX, +84% at week 24 versus week 0). There was a trend for rise in serum sclerostin (p = 0.09) and interleukin 6 (IL‐6) (p = 0.08), but no significant change in serum myostatin (p = 0.99). Volumetric BMD by QCT declined significantly at the femoral neck (−3.7% at week 24 versus week 0), particularly at the trabecular compartment. On MRI, there were no significant changes in thigh muscle fat fraction. On physical testing, men developed weaker grip strength, but experienced no worsening in lower extremity and lumbar spine muscle strength, or on functional tests of gait. In conclusion, in physically active men, ADT for 24 weeks results in a significant increase in bone resorption and reduction in BMD, but nonsignificant changes in thigh muscle quality (on imaging) or strength and gait (on functional testing). © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.