Effects of three therapeutic regimens on postmenopausal bone loss in oophorectomized women

Pharmacotherapy of osteoporosis in postmenopausal women: focus on safety

The therapy of osteoporosis has made enormous strides in the last decade. There is now a range of interventions, each with its pros and cons. Calcium and vitamin D supplementation remain the foundation and have few safety issues. Bisphosphonates are widely used, though gastrointestinal tolerance is a problem with some oral preparations. Intravenous administration may circumvent this, although this introduces the smaller problem of acute phase reactions. The side effect profile of hormone replacement therapy (HRT) is still being delineated after 40 years of use, with substantial new information expected in the next few years. This will clarify its place in the medical management of the menopause. Raloxifene appears to have a superior safety profile to HRT, though its efficacy on bone may be less. While none of these options is suitable for everyone, the range of available therapies does mean that most patients can find an intervention that is effective and acceptable.

Increase of bone alkaline phosphatase after androgen deprivation therapy in patients with prostate cancer

OBJECTIVES

To evaluate the behavior of bone alkaline phosphatase (BAP) after androgen deprivation therapy in patients with prostate cancer.

METHODS

BAP was determined in the serum of 35 patients with nonmetastatic prostate cancer before maximal androgen blockade. During 5 years of follow-up, BAP was determined annually. A subset of 36 patients who underwent radical prostatectomy as the only treatment for prostate cancer was selected as a control group.

RESULTS

The mean pretreatment BAP serum concentration was similar in both groups (10.8 and 10.4 ng/mL, P >0.05). However, after 5 years, the mean BAP serum concentration increased 64.8% in the study group (from 10.8 to 17.6 ng/mL, P < 0.001); it remained stable in the control group (from 10.4 to 10.4 ng/mL). The increase of serum BAP in patients receiving androgen deprivation was 32.4% during the first year (from 10.8 to 14.3 ng/ml), 16.7% during the second (from 14.3 to 16.1 ng/mL), 7.4% during the third (from 16.1 to 16.9 ng/mL), 5.5% during the fourth (from 16.9 to 17.3 ng/mL), and 2.8% during the fifth year (from 17.3 to 17.6 ng/mL).

CONCLUSIONS

Androgen deprivation produces an increase in the BAP serum concentration. A major increase seems to be produced during the first year of follow-up and thereafter this increase is reduced around 50% annually.