We assessed the relationship between GnRH agonists and the risk of clinical fractures in men with prostate cancer.
Using a database of medical claims from 16 large American companies we identified a study group of 3,779 men with prostate cancer who received treatment with a GnRH agonist and a control group of 8,341 with prostate cancer who were not treated with a GnRH agonist. Men with 1 or more medical claims for bone metastases were excluded. The rates of any clinical fracture, hip fracture and vertebral fracture were compared between the groups.
The rate of any fracture was 7.91/100 vs 6.55/100 person-years at risk in men who received vs did not receive a GnRH agonist (relative risk 1.21, 95% CI 1.09 to 1.34). The rates of hip fracture (relative risk 1.76, 95% CI 1.33 to 2.33) and vertebral fracture (relative risk 1.18, 95% CI 0.94 to 1.48) were also higher in men who received a GnRH agonist. GnRH agonist treatment was independently associated with fracture risk on multivariate analyses.
GnRH agonists increase the risk of clinical fracture in men with prostate cancer.
"This has been linked to an increased risk for osteoporotic fracture during and after the use of ADT. A retrospective study of over 12,000 men demonstrated a relative risk of 1.21 for any fracture, 1.18 for vertebral fracture, and 1.76 for hip fracture for patients who had received ADT . This increased risk has also been correlated to a number of doses of ADT administered . "
[Show abstract][Hide abstract] ABSTRACT: Androgen deprivation therapy is commonly used in combination with radiotherapy as part of the definitive treatment for men with clinically localized and locally advanced prostate cancer. Androgen deprivation has been associated with a wide range of iatrogenic effects impacting a variety of body systems including metabolic, musculoskeletal, cardiovascular, neurocognitive, and sexual. This review aims to provide the radiation oncology community with the knowledge to monitor and manage androgen deprivation therapy toxicity in an effort to provide the highest level of care for patients and to minimize the iatrogenic effects of androgen deprivation as much as possible.
"Several studies have shown that the maximal decline in BMD takes place in the first year of ADT treatment, with up to 10% decline in that first year [12, 14–16]. This BMD decline is evident even within months of starting ADT  and subsequently leads to an increase in rate of fractures  . "
[Show abstract][Hide abstract] ABSTRACT: Introduction. ADT is used in the management of locally advanced and metastatic disease. The detrimental effect of ADT on bone density is well documented. This study assesses care gaps in screening, prevention and treatment of osteoporosis among prostate cancer patients. Methods. We conducted a retrospective cohort study for patients diagnosed with non-metastatic prostate cancer on ADT. Charts from a tertiary oncology center were assessed for utilization of DXA scan, prescription of calcium, vitamin D, calcitonin and bisphosphonates.Bivariate analysis was used to determine the effect of patient characteristics and likelihood for osteoporosis screening. Results. 149 charts were reviewed, with 3-year mean follow-up. 58.8% of men received a baseline DXA, of which 20.3% had a repeat DXA within their follow-up periods.In all, 28% were appropriately screened and managed for osteoporosis (received repeat DXA, bisphosphonate). In bivariate analysis, the number of ADT injections which correlate with the duration of androgen suppression was significantly associated with the number of DXA scans. Conclusions. Our study found a care gap in the screening, prevention, and treatment of osteoporosis in this population. Patients receiving the most ADT injections were more likely to be screened. Our results suggest healthcare providers treating prostate cancer are insufficiently screening and treating this susceptible population. We suggest baseline measurement of BMD at the initiation of ADT with periodic reassessment during therapy.
Journal of Oncology 04/2012; 2012(6):958596. DOI:10.1155/2012/958596
"The incidence of fractures in men receiving ADT is also elevated, approaching 20% after 5 years of therapy . Several large population-based studies demonstrated a 21–45% relative increase in fracture risk among men being treated with ADT when compared to men without such treatment [15–17]. A recent analysis of SEER and Medicare data including over 50,000 men found a 19.4% rate of fracture in men receiving ADT as opposed to a rate of 12.6% in those who were not (P < 0.001) . "
[Show abstract][Hide abstract] ABSTRACT: Male osteoporosis is an increasingly recognized problem in aging men. A common cause of male osteoporosis is hypogonadism. Thousands of men with prostate cancer are treated with androgen deprivation therapy, a treatment that dramatically reduces serum testosterone and causes severe hypogonadism. Men treated with androgen deprivation therapy experience a decline in bone mineral density and have an increased rate of fracture. This paper describes prostate cancer survivors as a model of hypogonadal osteoporosis and discusses the use of RANKL-targeted therapies in osteoporosis. Denosumab, the only RANKL-targeted therapy currently available, increases bone mineral density and decreases fracture rate in men with prostate cancer. Denosumab is also associated with delayed time to first skeletal-related event and an increase in bone metastasis-free survival in these men. It is reasonable to investigate the use of RANKL-targeted therapy in male osteoporosis in the general population.
Journal of Osteoporosis 10/2011; 2011(4):941310. DOI:10.4061/2011/941310
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