Date: Monday, November 6, 2017
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Prostate cancer is the most common male malignancy. It is hormone dependent and androgenic inhibition with LHRH agonists is one of the mainstays of treatment. There are different treatment scheme’s options; continuous or intermittent in order to decrease secondary effects. As for bone effects, LHRH agonists therapy increase bone resorption, reduce bone mineral density (BMD), which leads to an increase in the risk of fracture. The influence of the different treatment schemes in bone metabolism has not been studied enough. The aim of this study is to evaluate the LHRH agonist treatment schemes effect in bone metabolism in prostate cancer patients and to evaluate whether antiresorptive treatment decreases the risk of osteoporosis according to different scheme of LHR agonists.
We recruited patients from the Prostate Cancer Protocol of Osteoporotic Risk Assessment. Patients were evaluated in a first visit (month 0) and at 6, 12, 18 and 24 months. We collected the following data: markers of bone turnover (serum BCTX and P1NP), BMD of the lumbar spine, femoral neck, and total hip, LHRH agonists treatment scheme, PSA and testosterone levels, and antiresorptive treatment. Biostatistical analysis with R (3.3.2.) was performed.
We selected 45 prostate cancer patients without bone metastasis with a minimum follow up of 12 months, 36 of them completed 24 months follow up. The mean age at prostate cancer diagnosis was 68.33 (9.02) years, with a mean Gleason score of 7 (1). 15 patients had intermittent LHRH agonists treatment scheme and 30 had continuous treatment scheme. 17 patients initiated antiresorptive treatment (mostly denosumab), 7 of them under intermittent LHRH agonist therapy. At baseline evaluation 16.7% of patients had osteoporosis and the 45.2% had osteopenia. 43.2% of patients had vitamin D values under 20ng/ml and 31.1% showed increased PTH values. Vitamin D and PTH levels were normalized, with supplementation, during the follow-up. Statistical analysis using a multivariable linear mixed model show that antiresorptive treatment had significant influence in femoral neck and total hip BMD (P<0.001 and P<0.001 respectively). Beta-CTX levels are related to the total hip BMD value (P=0.019) in patients with no antiresorptive treatment. Furthermore, in patients receiving intermittent LHRH agonist scheme and without antiresorptive treatment there was an increase total hip and femoral neck BMD values, in comparison to patients receiving continuous LHRH agonist treatment without antiresorptive treatment who had a decrease of total hip and femoral neck BMD values (coef= 0.89; 95% CI 0.09-1.75 and coef= -0.28; 95% CI -0.99-0.46). No fractures have been detected during the follow up period.
In our patients cohort we detected a high prevalence of vitamin D deficiency. In patients without antiresorptive treatment, evolution of BMD values correlated to betaCTX levels during the follow-up. Moreover, patients without antiresorptive treatment under intermittent treatment with LHRH agonist display positive effects in total hip BMD values compared to patients receiving continuous LHRH regimen.
To cite this abstract in AMA style:Arevalo Ruales K, Ivorra Cortes J, Vera Donoso CD, Grau Garcia E, Alcañiz Escandell C, Canovas Olmos I, Chalmeta Verdejo I, Feced Olmos C, Fragio Gil JJ, Gonzalez Mazario R, Gonzalez Puig L, Labrador Sanchez E, Martinez Cordellat I, Najera Herranz C, Negueroles Albuixech R, Oller Rodriguez JE, Ortiz-Sanjuán FM, Vicens Bernabeu E, Hervás Marín D, De la Rubia Navarro M, Roman Ivorra JA. Differences in BONE Metabolism between Intermittent and Continuous Treatment with LHRH Agonists in Prostate Cancer Patients [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/differences-in-bone-metabolism-between-intermittent-and-continuous-treatment-with-lhrh-agonists-in-prostate-cancer-patients/. Accessed October 19, 2021.
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