Bone Mineral Density Changes in Patients With Prostate Cancer During the First 2 Years of Androgen Suppression

Abstract

Bone mineral density decreases during the first 24 months of androgen suppression with the most relevant effect occurring in the first year. Ward's triangle is the axial skeletal site that reflects the major bone mass loss. Because the deleterious impact of long-term androgen suppression on bone mineral density is inversely related to fracture risk and indirectly related to survival in patients with prostate cancer, early diagnosis and prevention of bone mass loss are warranted in these patients.

Bone mineral density in Japanese prostate cancer patients under androgen-deprivation therapy

“…However, it remains unclear whether ADT has a similar influence on the BMD of East Asian patients with PCa. Although other studies found a high incidence of osteoporosis in western ADT-treated patients with PCa (Bruder et al 2006, Morote et al 2006, we found that this was not true for Japanese patients with PCa, as only 10.8% (4/37) of the ADT-treated patients exhibited osteoporosis. However, ADT did mildly promote osteoporosis in Japanese PCa patients, as even fewer of the hormone-naive PCa patients (2.3%; 1/43) had osteoporosis, although this difference from ADT-treated patients did not quite achieve statistical significance (PZ0.294).…”

“…The effect of ADT on BMD and its ability to induce osteoporosis in Caucasians and blacks, mainly in western countries, are now well documented (Greenspan et al 2005, Bruder et al 2006, Morote et al 2006. However, it remains unclear whether ADT has a similar influence on the BMD of East Asian patients with PCa.…”

“…It is possible that we did not detect a significant difference in BMD between ADT-treated and hormone-naive PCa patients (PZ0.294) because the patients in this study only received ADT for a relatively short period (on average 23.5 months). However, many studies of Caucasian patients with PCa have shown high incidences of osteoporosis in patients receiving ADT for similarly short durations; moreover, even ADT-naive Caucasian patients show a high incidence of osteoporosis (Bruder et al 2006, Morote et al 2006. For example, Bruder et al (2006) showed that of 89 patients with a median duration of ADT of 2.7G2.5 years, whose BMDs in the spine and total hip had been measured, 26.9 and 50.6% had osteoporosis and osteopenia respectively.…”

“…Of these ADT complications, increasing bone resorption is of particular concern, because it may lead to osteoporosis and bone fractures (Smith 2004, Shahinian et al 2005. Indeed, a number of studies have shown that ADT-treated patients with PCa suffer from bone loss and skeletal-related adverse effects (Greenspan et al 2005, Bruder et al 2006, Morote et al 2006, and a recent clinical report disclosed a negative correlation between skeletal fractures and overall survival in ADT-treated patients with PCa (Oefelein et al 2002). These observations have led to the suggestion that clinicians should be alert to the impact of ADT on bone mineral density (BMD) and should strive to prevent bone loss.…”

Risedronate prevents early bone loss and increased bone turnover in the first 6 months of luteinizing hormone‐releasing hormone‐agonist therapy for prostate cancer

“…It is likely that we did not see changes at the lumbar spine in 6 months due to degenerative changes and the small group. However, changes were significant at the hip and are consistent with previous data in which there was significant bone loss within the first 6 months of ADT [3,4,12]. As in the present study, these investigators did not find significant differences in gastrointestinal symptoms between groups.…”