Bone fractures associated with luteinizing hormone-releasing hormone agonists used in the treatment of prostate carcinoma

Townsend, Murphy F.; Sanders, William H.; Northway, Robert O.; Graham, Sam D.

doi:10.1002/(sici)1097-0142(19970201)79:3<545::aid-cncr17>3.0.co;2-3

Cited by 251 publications

(95 citation statements)

References 36 publications

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“…Using both hospital records and telephone interviews, those authors noted that 20 men (9%) had suffered a fracture. 21 Hatano et al, in a similar retrospective study over 5 years, reported a 6% incidence of fractures in men treated with ADT for Ͼ 6 months. 22 In the most detailed study to date, Oefelein et al found that 23 spinal fractures occurred in 181 men (12.7%) who were treated with ADT for 180 months, with 67% of the surviving men remaining free of fractures.…”

Section: Fracture Rates In Men and Women Who Present With Osteoporosismentioning

confidence: 95%

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Osteoporosis in men with prostate carcinoma receiving androgen‐deprivation therapy

Diamond

Higano

Smith

et al. 2004

Cancer

242

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BACKGROUNDAndrogen‐deprivation therapy (ADT) is prescribed with increasing frequency for men with prostate carcinoma. There is growing concern about the effects of such therapy on the skeleton. In the current review, the authors addressed the current research, diagnostic methods, and treatment recommendations for bone loss and osteoporosis in men with prostate carcinoma who received ADT.METHODSData were obtained from electronic literature searches (for the years 1986 through 2002) and from abstracts and meeting proceedings. All randomized and nonrandomized clinical trials, retrospective studies, and cross‐sectional studies of osteoporosis in men with prostate carcinoma who received ADT with or without other therapies were reviewed.RESULTSThe findings confirmed that ADT resulted in significant bone loss in men with prostate carcinoma. Bone mineral density (BMD) of the hip, as measured by dual‐energy X‐ray absorptiometry (DXA), is considered the preferred site of assessment in older men. Spinal BMD is equally important, although careful interpretation of spinal DXA values is required, because of coexisting facet joint disease and extravertebral calcification. Osteoporosis is diagnosed when BMD is > 2.5 standard deviations below a reference mean. Men with prostate carcinoma who were treated with ADT had average BMD measurements below those of eugonadal men. Rates of bone loss ranged from 2% to 8% in the lumbar spine and from 1.8% to 6.5% in the femoral neck during the initial 12 months of continuous ADT. Retrospective data indicated an increased risk of fracture in men with prostate carcinoma who were treated with ADT.CONCLUSIONSFor men with prostate carcinoma who are at high risk for osteoporosis and fractures, clinical management should be dictated by the results of radiographic and DXA skeletal assessment. Cancer 2004;100:892–9. © 2004 American Cancer Society.

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Section: Fracture Rates In Men and Women Who Present With Osteoporosismentioning

confidence: 95%

“…fracture rates [21][22][23][24][25] have been reported in men with prostate carcinoma who are receiving ADT. Because many patients who present with prostate carcinoma are elderly and may have preexisting osteoporosis, subclinical vitamin D deficiency, or any of a multitude of medical problems, the risk of skeletal deterioration is increased.…”

mentioning

confidence: 99%

Osteoporosis in men with prostate carcinoma receiving androgen‐deprivation therapy

Diamond

Higano

Smith

et al. 2004

Cancer

242

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“…There is enough data to suggest that androgen deprivation therapy is associated with increased fracture risk in patients with prostate cancer with as much as 5% fracture incidence. 20,9,8,21 We noted marked changes at the hip. Total hip BMD was the strongest predictor of fracture risk in women where as wrist BMD was best in men.…”

Section: Discussionmentioning

confidence: 81%

Bone mineral density changes on androgen deprivation therapy for prostate cancer and response to antiresorptive therapy

Yaturu

Djedjos

Alferos

et al. 2005

Prostate Cancer Prostatic Dis

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Androgen deprivation therapy improves survival of patients with prostate cancer and leads to hypogonadal state. Gonadal hormones are essential for skeletal integrity and hypogonadism constitutes a major risk factor for osteoporosis. To examine the bone loss secondary to androgen deprivation therapy, we reviewed the bone mineral density (BMD) studies of 152 patients with prostate cancer with mean duration of androgen deprivation therapy of 58 months. Among them 55 subjects had follow-up BMD measurement at 12-15 months with 39 of them on antiresorptive therapy. Osteoporosis was noted at least at one site in 92 (60.5%), among which 74 (48.7%) had changes at hip with the more prominent changes at ward's triangle, 18 (11.8%) at other sites. Osteopenia was present in 37 (24%) and only 17 (11%) were normal. The duration of antiandrogen therapy did not correlate with the degree of bone loss. Significant in improvement in the BMD is noted at 12-15month followup on antiresorptive therapy. We conclude that men treated with androgen deprivation therapy are at risk for bone loss and should have BMD measured at the time of initiation of androgen deprivation therapy and periodically.

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“…17 The rate of bone loss following commencement of androgen deprivation has been estimated at 4% per year. 18 This rate was found to fall to 2% in men who had received androgen deprivation for more than 3 y and compared to a slight increase in matched controls.…”

Section: Discussionmentioning

confidence: 99%

Bone loss associated with the use of LHRH agonists in prostate cancer

Peters¹,

Fairney

Kyd

et al. 2001

Prostate Cancer Prostatic Dis

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Hypogonadism is a recognised cause of osteoporosis in men. When patients with advanced prostate cancer are treated with luteinising hormone releasing hormone (LHRH) agonist analogues their circulating testosterone levels decline and these patients may develop fractures.We have undertaken a cross-sectional study on a cohort of patients treated with goserelin (n ¼ 41) and compared their bone density and bone turnover with patients with prostate cancer not on goserelin and elderly patients living in the community.There was no difference in bone density between the patients on treatment and those living in the community and there was a similar incidence of osteoporosis (50 and 42%, respectively). The bone marker measurements were higher in the treated patients: urine N-telopeptide (NTX) 80.1 (9) (mean (s.e.)) BCE/mmol, compared to 30.1 (2.9), P < 0.001 in elderly patients; and bone alkaline phosphatase 41.9 (6.1) u/l in treated patients and 20.7 (1.5) in untreated prostate cancer patients, P < 0.002. Patients on treatment with radionuclide scan evidence of metastases did not have higher bone marker values than those with negative scans.As increased bone turnover and low bone density are associated with enhanced risk of osteoporotic fractures, we suggest that patients on LHRH agonist analogues should receive advice and possibly anti-bone resorptive treatment with bisphosphonates to prevent further bone loss and fractures. Prostate Cancer and Prostatic Diseases (2001) 4, 161-166.

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Bone fractures associated with luteinizing hormone-releasing hormone agonists used in the treatment of prostate carcinoma

Cited by 251 publications

References 36 publications

Osteoporosis in men with prostate carcinoma receiving androgen‐deprivation therapy

Osteoporosis in men with prostate carcinoma receiving androgen‐deprivation therapy

Bone mineral density changes on androgen deprivation therapy for prostate cancer and response to antiresorptive therapy

Bone loss associated with the use of LHRH agonists in prostate cancer

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