前立腺癌のアンドロゲン除去療法におけるビスフォスフォネートの臨床的意義 : リセドロネートの検討  [in Japanese] CLINICAL SIGNIFICANCE OF RISEDRONATE FOR PATIENTS WITH PROSTATE CANCER RECEIVING ANDROGEN DEPRIVATION THERAPY  [in Japanese]

(目的)前立腺癌に対するアンドロゲン除去療法に伴う骨密度の減少に対するリセドロネートの有用性について,prospectiveに検討を行った.(対象と方法)2004年4月より2005年12月にGnRHアゴニスト投与を含めた内分泌療法を開始したホルモンナイーブ前立腺癌症例69例(リセドロネート2.5mg/day服用群58例,コントロール群11例)を対象とした治療開始前に骨密度,ならびに尿中NTXを測定し,以後6ヵ月毎に測定・フォローアップを行った.(結果)ベースラインにおける両群の腰椎と大腿骨頚部の骨密度に有意差は認めなかった骨密度に関しては,6ヵ月後の時点で腰椎(p=0.002)と大腿骨頚部(p=0.030)において,12ヵ月後の時点で腰椎(p=0.038)において,リセドロネート群がコントロール群と比較してベースラインからの骨密度変化率(%)が有意に低かった,尿中NTXに関しては,12ヵ月後の時点でリセドロネート群がコントロール群と比較してベースラインからの尿中NTX変化率(%)が有意に低かった(p=0.017).(結論)アンドロゲン除去療法においては,すでに加療後6ヵ月の時点で骨量は減少を呈してきている事が確認された,同病態に対して骨塩量減少の予防および維持のため,急性期からのリセドロネート内服が短期的には有用であることが確認された.

(Purpose) Androgen deprivation therapy (ADT) in patients with prostate cancer is associated with bone loss. We investigated the effectiveness of risedronate about a decreasing bone mineral density in patients with prostate cancer on ADT. (Material and method) A prospective study was conducted in Kitasato University Hospital from April 2004 to October 2006. A total of 69 men with prostate cancer were assigned to receive either oral risedronate or none during ADT (hormone naive). The treatment group was 58 men and taking2.5mg risedronate per day. The control group was 11 men. At baseline, we assessed BMD (bone mineral density) by DEXA and urinary NTX, and measured for these changes every 6 months. (Result) At baseline, each BMDs had no significant difference at the lumber and total hip. At the first 6-month stage, the change in BMD percentage between the 2 groups was statistically significantly different at lumber (p=0.002) and total hip (p=0.038). At the 12-month stage, the change in the BMD percentage between the 2 groups was statistically significantly different at the lumber (p=0.038). And each difference made out that the risedronate group was preserving BMD. In urinary NTX, bone turn over was statistically significantly decreased with the risedronate group compared with the control group at the 12-month stage (p=0.017). (Conclusion) We assure the beginning of bone loss at an early date (6 months) with ADT. Daily oral risedronate in patients with receiving ADT reduces bone mineral loss and maintain BMD.