br Patients whose bones metastases were limited to thoracic
Patients whose bones metastases were limited to thoracic region were significantly more likely to have a primary thoracic tumor. Similarly, among patients with only one involved bone, patients with pelvic primary tumors were significantly more likely to have pelvic bone metastases, and those with cervical area primary tumors were significantly more likely to have cervical spine bone metastases; how-ever, this was not true of patients with multiple involved bones. Therefore, single but not multiple bone metastases may be clues to the locations of primary tumors in patients with CUPs.
Diﬀerences between bone 2062-78-4 distributions of breast cancer and lung cancer may show the discrepancy between the vertebral ve-nous plexus spreading bone metastasis pattern of tumors in thoracic cavity and out of thoracic cavity, which may reflect diﬀerent drainage routes of vertebral venous plexus from intrathoracic tumors and breast r> Table 2
The distribution of bone metastases among the total 290 patients.
cancer, and this may warrant further research.
Although tumors are generally incurable once they have metasta-sized to bone [28,29], exact targeting of the primary tumor can help to develop more individualized treatments . Even if a cure is no longer possible, treating the cancer may help the patient live longer and feel better [31,32].
Our study had some limitations. Notably, our cohort had a larger proportion of thorax tumors and low proportion of other tumors, which seems to reflect the higher bone metastatic rate of breast cancer and lung cancer; however, this distribution may have biased the results. Therefore, a study based on a larger cohort with more varied primary tumors is warranted.
We observed characteristics of bone metastatic distribution in pa-tients with only one bone containing a metastasis but no visceral dis-eases. And we found that bones near the primary were more likely to be first metastasized. This may provide a valuable clue to the primary tumor in patients with cancers of unknown primaries.
Skull metastasis Cervical spine metastasis Thoracic bones metastasis Lumbar spine metastasis Pelvis metastasis Extremities metastasis
MYZ, XL, YQ participated in acquiring, analyzing and interpreting data, and drafting the manuscript. XL, SLH, YJZ, WTL, XYZ, HJY, LPZ, QFW, YFH, YC, YLW, YHW, ZWL, ZGL, and XCH contributed to con-ception and design the study, and enhanced its intellectual content. MYZ, XL, SLH, and XCH revised the manuscript. All authors read and approved the final content of the manuscript.
Conflict of interest statement
The authors declare no conflicts of interest.
This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Full Length Article
Bone mineral density, structure, distribution and strength in men with prostate cancer treated with androgen deprivation therapy
Jack Dalla Viaa, , Robin M. Dalya, Patrick J. Owena, Niamh L. Mundella, Timo Rantalainena,b, Steve F. Frasera a Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia b Gerontology Research Centre and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
Androgen deprivation therapy
Bone mineral density
Androgen deprivation therapy (ADT) improves survival in men with advanced prostate cancer (PCa), but has been associated with compromised skeletal health and increased fracture risk. However, limited previous re-search has investigated determinants of bone strength beyond DXA-derived areal bone mineral density (aBMD) in this population group. The aim of this cross-sectional study was to investigate the effects of ADT in men with PCa on BMD, bone structure, estimates of whole bone strength and cortical bone distribution. A total of 70 ADT-treated men, 52 PCa controls and 70 healthy controls had DXA lumbar spine and proximal femur aBMD and pQCT distal (4%) and proximal (66%) tibia and radius cortical and trabecular volumetric BMD (vBMD), bone structure, strength and cortical bone distribution assessed. Analyses included BMI and/or tibia/radius length as covariates. On average, ADT-treated men had a higher BMI than PCa (P < 0.05) but not healthy controls. ADT-treated men had 7.2–7.8% lower lumbar spine aBMD than PCa (P = 0.037) and healthy controls (P = 0.010), with a trend for a lower total hip aBMD in the ADT-treated men (P = 0.07). At the distal tibia, total bone area was 6.2–7.3% greater in ADT-treated men than both controls (P < 0.01), but total vBMD was 8.4–8.7% lower in ADT-treated men than both controls (P < 0.01). Moreover, bone strength index (BSI) was 10.8% lower relative to healthy controls only (P < 0.05). At the distal radius, ADT-treated men had lower total and trabecular vBMD (10.7–14.8%, P < 0.05) and BSI (23.6–27.5%, P < 0.001) compared to both controls. There were no other differences in bone outcomes at the proximal tibia or radius. In conclusion, ADT treatment for PCa was asso-ciated with lower BMD and estimated compressive bone strength, particularly at trabecular skeletal sites (lumbar spine, and distal tibia and radius), compared to controls, but there were no consistent differences in cortical bone structure, distribution or bending strength.