[Administration of 1 alpha-OH vitamin D3 and calcium prevents bone mass loss in patients with advanced prostatic carcinoma after orchidectomy treated with complete androgenic blockade].
Complete androgenic blockade used in the treatment of advanced prostatic carcinoma can be attained by administration of antiandrogens in orchidectomized patients or by combined therapy with LH-RH analogs and antiandrogens. The treatment, however, decreases the influence of both androgens end estrogens on bone tissue and may result in bone mass loss and increased propensity to fractures. The purpose of the study was to determine the influence of complete androgenic blockade on bone mass and skeletal metabolism in men with advanced prostatic carcinoma and to assess whether 1alpha-OH vitamin D3 (1alpha-OHD3) together with calcium supplementation is able to prevent bone mass loss in men treated with complete androgenic blockade. 51 patients with advanced prostatic carcinoma, with skeletal metastases, aged 44 - 86, mean 68 ys were included into a 12-month prospective study. All patients were treated with orchidectomy followed by therapy with flutamide in a dose of 750 mg daily. 26 patients were additionally given 1alpha-OHD3 in a dose of 0.5 microg/d and calcium carbonate in an initial dose of 1 g daily. It was found that the 12-month treatment with complete androgenic blockade resulted in a decrease in bone mineral density (BMD) by 8.1% in the lumbar spine, by 6.3% in the femoral neck and by 3.5% in the total skeleton. Therapy with 1alpha-OHD3 and CaCO3 caused complete inhibition of bone tissue loss in the lumbar spine and resulted in an increase in BMD by 2.2% in femoral neck and by 1.9% in the total skeleton. None of the examined patients experienced any skeletal fractures. In both groups of patients a prompt decrease in serum alkaline phosphatase activity - a marker of osteoblast activity and an increase in fasting urine calcium creatinine ratio indicating acceleration of bone resorption were found.


CONCLUSIONS
in patients with advanced prostatic carcinoma treated with complete androgenic blockade acceleration of bone mass loss is observed; treatment with 1alpha-OHD3 and CaCO3 is able to prevent both trabecular and compact bone loss.
Tałalaj
Marek
M
Department of Family and Internal Medicine, Postgraduate Medical Education Centre, Warsaw.
Kapitan-Malinowska
Barbara
B
Debski
Krzysztof
K
Nowakowski
Robert
R
Marcinowska-Suchowierska
Ewa
E
Witeska
Alojzy
A
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects*; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D001861:Bone Regeneration / Q000187:drug effects; D002118:Calcium / Q000097:blood; D002136:Calcium, Dietary / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005485:Flutamide / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D006887:Hydroxycholecalciferols / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy / Q000009:adverse effects*; D010018:Osteomalacia / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000628:therapy*
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D050071:Bone Density Conservation Agents; D002136:Calcium, Dietary; D006887:Hydroxycholecalciferols; D005485:Flutamide; D002118:Calcium; C008088:alfacalcidol