A systematic review and meta-analysis of bone metabolism in prostate adenocarcinoma.

Abstract

Background: Osteoporosis could be associated with the hormone therapy for metastatic prostate carcinoma (PCa) and with PCa per se. The objective of this review is to determine the incidence of bone loss and osteoporosis in patients with PCa who are or are not treated with hormone therapy (ADT). Methods:The Medline, Embase, Cancerlit, and American Society of Clinical Oncology Abstract databases were searched for published studies on prostate cancer and bone metabolism. The outcomes assessed were: fracture, osteoporosis and osteopenia.Results: Thirty-two articles (116,911 participants) were included in the meta-analysis. PCa patients under ADT had a higher risk of osteoporosis (RR, 1.30; p < 0.00001) and a higher risk of fractures (RR, 1.17; p < 0.00001) as compared to patients not under ADT. The total bone mineral density was lower in patients under ADT when compared with patients not under ADT (p = 0.031) but it was similar to bone mineral density found in healthy controls (p = 0.895). The time of androgen deprivation therapy correlated negatively with lumbar spine and total hip bone mineral density (Spearman's rho = -0.490 and -0.773; p = 0.028 and 0.001, respectively) and with total hip t score (Spearman's rho = -0.900; p = 0.037). Conclusion:We found consistent evidence that the use of androgen deprivation therapy in patients with PCa reduces bone mineral density, increasing the risk of fractures in these patients. BackgroundProstate cancer (PCa) is the most common cancer in men in many Western countries and is the second leading cause of cancer death in men [1]. PCa is characterized by its propensity for bone metastases which occur in more than 80% of patients with advanced prostate cancer [2,3]. Typical metastasis sites include the spine, pelvis and rib cage [4]. The median survival time of patients with PCa is approximately three years after the development of bone metastases, and during this period, patients are at risk of pain, hypercalcaemia, fracture and spinal cord compression [5].Another feature of patients with PCa is bone loss and, in a more advanced period, osteoporosis. Antihormonal therapy used to inhibit the disease progression or prevent its recurrence can lead to changes in bone metabolism, resulting in the loss of bone mineral density (BMD) since