Fracture risk following bilateral orchiectomy
Fracture risk following bilateral orchiectomy
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DOI：
10.1097/01.ju.0000059281.67667.97
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发表时间：
2003-05-01
影响因子：
6.6
通讯作者：
Zincke, H
中科院分区：
文献类型：
--
作者：
Melton, LJ;Alothman, KI;Zincke, H
目的：据报道，前列腺癌患者接受雄激素剥夺治疗后出现骨丢失。我们评估骨折的风险，双边orchiectomy.Materials和方法：通过罗切斯特流行病学项目，我们确定了429奥姆斯特德县，明尼苏达州的男子谁接受了双侧睾丸切除术在1956年至2000年，几乎所有的前列腺癌。骨折是从全面的医疗记录中确定的，并与基于当地发病率（标准化发病率比，SIR）的预期数字进行比较。结果：在1961人-年的随访中，161名男性经历了267次骨折，15年后的累积发病率为40%，而预期为19%（p < 0.001）。然而，42例为病理性骨折，82例在放射学检查中偶然发现转移。总体骨折风险增加（SIR 3.42，95% CI 2.91-3.99），但通过排除病理性和偶发性骨折降低了风险（SIR 2.04，95% CI 1.66-2.47）。增加的主要原因是髋关节、脊柱和远端的中度创伤骨折。前臂传统上与骨质疏松症相关（SIR 3.50，95% CI 2.71-4.43）。在多变量分析中，骨折的危险因素通常包括患者年龄、不活动、既往骨质疏松症的放射学诊断、化疗和非甾体抗雄激素的使用，而传统骨质疏松性骨折的独立危险因素包括年龄、不活动和骨质疏松症的诊断。骨折在患有前列腺癌的男性中很常见，病理性骨折的发生率和增强的骨骼监测，但双侧睾丸切除术后骨质疏松性骨折的风险仍显着增加。
Purpose: Bone loss has been reported in patients with prostate cancer treated with androgen deprivation therapy. We assess fracture risk following bilateral orchiectomy.Materials and Methods: Through the Rochester Epidemiology Project we identified 429 Olmsted County, Minnesota men who underwent bilateral orchiectomy in 1956 to 2000, almost all for prostate cancer. Fractures were ascertained from comprehensive medical records and compared with expected numbers based on local incidence rates (standardized incidence ratio, SIR). Potential risk factors were assessed with proportional hazards models.Results: During 1961 person-years of followup 161 men experienced 267 fractures, for a cumulative incidence after 15 years of 40% compared to 19% expected (p < 0.001). However, 42 were pathological fractures and 82 were found incidentally on radiological surveys for metastasis. Overall fracture risk was increased (SIR 3.42, 95% CI 2.91-3.99) but was reduced by excluding the pathological and incidental fractures (SIR 2.04, 95% CI 1.66-2.47). The increase was largely accounted for by the moderate trauma fractures of the hip, spine and distal. forearm traditionally linked with osteoporosis (SIR 3.50, 95% CI 2.71-4.43). In multivariate analyses risk factors for fractures generally included patient age, inactivity, prior radiological diagnosis of osteoporosis, chemotherapy and use of nonsteroidal antiandrogens, while independent risk factors for the traditional osteoporotic fractures included age, inactivity and diagnosis of osteoporosis.Conclusions: Fractures are common in men with prostate cancer due to advanced age, occurrence of pathological fractures and enhanced skeletal surveillance but there remains a significant increase in osteoporotic fracture risk following bilateral orchiectomy.