 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / Diseases and Disorders / Prostate Cancer / January 2008Managing Loss of bone Density
See: Israeli RS, et al, "Managing bone loss in men with locally advanced prostate cancer receiving androgen deprivation therapy." J Urol. 2008 Feb;179(2):414-23. "CONCLUSIONS: Because the most significant bone mineral density loss occurs within year 1 of androgen deprivation therapy and most fractures in healthy men occur in those without osteoporosis, early intervention is warranted to prevent skeletal morbidity in patients with nonmetastatic prostate cancer receiving androgen deprivation therapy. Although the majority of and the most compelling evidence supports the use of bisphosphonates for preventing and treating androgen deprivation therapy induced bone loss, further study is needed to define the optimal regimen, timing of initiation and duration of therapy as well as long-term efficacy and safety." Pub Med ID: 18076933. PubMed, a service of the National Library of Medicine, is at www.pubmed.gov Regards, Steve J I'd add that bone density issues arise in a significant proportion of men with PCa prior to their ever commencing ADT. It is not something that only affects men on ADT...ron On January 17, ron replied to me: > I'd add that bone density issues arise in a significant proportion of > men with PCa prior to their ever commencing ADT. It is not something > that only affects men on ADT. Or just women. All too true.... Regards, Steve J > I'd add that bone density issues arise in a significant proportion of > men with PCa prior to their ever commencing ADT. It is not something > that only affects men on ADT...ron That's a new one on me. Could you or anyone else support that? It may be important for men considering ADT or even for those of us not on ADT, especially with the problems arising with Fosamax. I.P. > That's a new one on me. Could you or anyone else support that? It may be > important for men considering ADT or even for those of us not on ADT, > especially with the problems arising with Fosamax. > > I.P. Hi I.P...Below, I've included an abstract that Dr. Strum often refers to when he discusses the PCa-BMD subject. As to "problems" with Fosamax, I suspect you are referring to the potential for ONJ. Below the firts abstract, I've posted another that brings some hopeful news to this subject...ron Cancer. 2001 Jun 15;91(12):2238-45. Low bone mineral density in hormone-naive men with prostate carcinoma. Smith MR, McGovern FJ, Fallon MA, Schoenfeld D, Kantoff PW, Finkelstein JS. Hematology-Oncology Division, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. smith.matthew@mgh.harvard.edu BACKGROUND: The objective of this study was to determine the prevalence of low bone mineral density in men with prostate carcinoma and no history of androgen-deprivation therapy. METHODS: The authors conducted a cross-sectional study in 41 hormone- naive men with locally advanced, lymph node positive, or recurrent prostate carcinoma and no radiographic evidence of bone metastases. Bone mineral density of the total hip, posterior-anterior (PA) lumbar spine, and lateral lumbar spine was determined by dual-energy X-ray absorptiometry (DXA) using a densitometer. Trabecular bone mineral density of the lumbar spine was determined by quantitative computed tomography (QCT). Bone mineral density results were expressed in standard deviation units relative to young adult men (T score) and relative to age-matched men (Z score). RESULTS: Fourteen of 41 men (34%; 95% confidence interval [95% CI], 20-51%) had T scores < -1.0 at one or more skeletal sites by DXA, 12 of 41 men (29%; 95% CI, 16-42%) had T scores between -1.0 and -2.5, and 2 of 41 men (5%; 95% CI, 1-17%) had T scores < -2.5. Thirty-nine of 41 men (95%; 95% CI, 83-99%) had T scores < -1.0 by QCT, 13 of 41 men (31%; 95% CI 18-48%) had T scores between -1.0 and -2.5, and 26 of 41 men (63%; 95% CI, 47-78%) had T scores < -2.5. T scores for trabecular bone mineral density of the lumbar spine were significantly lower than T scores for either the total hip (P < 0.001) or the PA lumbar spine (P < 0.001). The mean Z score for trabecular bone mineral density of the lumbar spine was -0.7 +/- 0.9. Hypogonadism, hypovitaminosis D, and dietary calcium intakes below the Recommended Daily Allowance were observed in 20%, and 17%, and 59% of study participants, respectively. CONCLUSIONS: Many hormone-naive men with prostate carcinoma have low bone mineral density. QCT is a more sensitive method than DXA for diagnosing low bone mineral density in this patient population. Trabecular bone mineral density is lower than expected for age and risk factors for osteoporosis are common. ---------------------------------------------------------------------------------------------------------------------- By Reuters Health January 4, 2008 NEW YORK (Reuters Health), Jan 4 - A report in the Journal of the American Dental Association for January clarifies the risk of jaw osteonecrosis associated with bisphosphonates. Intravenous bisphosphonates strongly increase the risk of adverse jaw outcomes, but oral bisphosphonates tend to decrease the risk, the research shows. "This is good news for the roughly 3 million Americans who take Fosamax, Actonel, Boniva, or similar osteoporosis meds orally," senior author Dr. Athanasios Zavras, from Harvard School of Dental Medicine in Boston, said in a statement. In 2003, reports first surfaced linking intravenous bisphosphonate use with osteonecrosis of the jaw. Oral versions of these agents were initially thought to be safe until a report came out in May 2005 showing that seven of 63 bisphosphonate users who developed the condition had been using oral forms. To investigate further, the researchers analyzed medical claims from 714,217 patients with osteoporosis or cancer to determine the effect that bisphosphonate use had on the risk of three outcomes: inflammatory conditions of the jaw (including osteonecrosis), major jaw surgery for necrotic indications, and jaw surgery for a malignant process. The results showed that intravenous bisphosphonate use was associated with odds ratios of 4.01 and 4.47 for inflammatory necrosis of the jaw among patients with osteoporosis and cancer, respectively, and with corresponding odds ratios of 7.80 and 6.80 for surgery for a necrotic process. No significant effect was noted regarding the risk of surgery for a cancer process. By contrast, oral bisphosphonate use reduced the risk of inflammatory necrosis of the jaw in patients with osteoporosis, with an odds ratio of 0.65. No significant effects of oral bisphosphonates were seen regarding surgery for a necrotic process in this patient group or for any of the adverse jaw outcomes in cancer patients. "Our findings on intravenous bisphosphonates are consistent with the literature, which makes me confident that our findings on oral bisphosphonates are correct," Dr. Zavras stated. "We're currently recruiting patients for a clinical study to confirm them." On January 17, ron wrote, in pertinent part: (ka-snip) > By Reuters Health > January 4, 2008 [quoted text clipped - 6 lines] > tend to > decrease the risk, the research shows. Anyone who relies upon such as this and especially the general press, all written by ignoramuses, to make treatment decisions deserves what they get. Which will not be pretty. Never, EVER, rely upon press articles about medical matters. Always seek out the primary source. Regards, Steve J > On January 17, ron wrote, in pertinent part: > [quoted text clipped - 14 lines] > written by ignoramuses, to make treatment decisions deserves what they > get. I agree. I sent it to all my male relations with the caveat that they would have to "separate the editorializing from the science". I ended up writing three paragraphs, mostly to steer them away from the author and toward the facts. > As to "problems" with > Fosamax, I suspect you are referring to the potential for ONJ. For starters, yes. But does the study referenced below implicate PC as causative, or leave the door open for other causes such as low T? > Low bone mineral density in hormone-naive men with prostate carcinoma. > Smith MR, McGovern FJ, Fallon MA, Schoenfeld D, Kantoff PW, > Finkelstein JS. I.P. > > As to "problems" with > > Fosamax, I suspect you are referring to the potential for ONJ. [quoted text clipped - 8 lines] > > I.P. I.P...The way I read it, there is an association between low BMD and PCa, but no evidence that one cuases the other. But who knows, perhaps one does cause the other or is there some other factor (low T, low vitamin D...) common between the two ailments that precipitates the event?..ron > > > As to "problems" with > > > Fosamax, I suspect you are referring to the potential for ONJ. [quoted text clipped - 14 lines] > low vitamin D...) common between the two ailments that precipitates > the event?..ron Studies generally have narrow parameters that are investigated. In the case of low BMD and PCa - here are other possibles effects not included: 1- was low BMD due to low vitamin D levels? or low calcium levels? 2- was low BMD due to low testosterone, consequently low estrogen levels? 3- was low BMD due to PCa causing deterioration of the bones? 4- or another unknown factor? These are questions raised by many doctors but I have not seen a study that deals with all the possible issues. Lud On January 17, Mike Freely wrote: Quoting Ron >> I'd add that bone density issues arise in a significant proportion >> of men with PCa prior to their ever commencing ADT. It is not >> something that only affects men on ADT Mike wrote: > That's a new one on me. Could you or anyone else support that? It may > be important for men considering ADT or even for those of us not on > ADT, especially with the problems arising with Fosamax. See Gennari L, "Osteoporosis in men: pathophysiology and treatment." Curr Rheumatol Rep. 2007 Apr;9(1):71-7. ...and the 14,100 related articles on Pub Med. The article sez: "Osteoporosis has long been long considered a disease of the aging female skeleton. However, it is now clear that men are also at risk for this disorder. Epidemiologic studies have confirmed that osteoporotic fractures in men are an increasing public health problem, in part due to increased longevity and increased public awareness." And I wonder to what "problems" with Fosamax (other than the predatory lawyer problem) Mike refers. Regards, Steve J |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.