High prevalence of vertebral fractures at initiation of androgen deprivation therapy for prostate cancer

Oostwaard, Marsha M. van; Bergh, J.P. van den; Wouw, Yes van de; Janssen‐Heijnen, M.L.G.; Jong, M. de; Wyers, Caroline E.

doi:10.1016/j.jbo.2022.100465

Cited by 7 publications

(6 citation statements)

References 43 publications

(68 reference statements)

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“…In a report examining the records of 50,613 men diagnosed with prostate cancer between 1992 and 1997, 19.4% of those who received ADT had a fracture, compared with 12.6% of those who did not receive androgen deprivation therapy (p < 0.001) [4]. A report on the prevalence of osteoporosis-related conditions at the time of ADT induction showed a prevalence of 4.3% for osteoporosis and 35.7% for osteopenia in 115 men (mean age 73.3 ± 7.6 years) with ADT induction [16]. FRAX calculations revealed a 10-year fracture risk incidence of 4.4% for osteoporotic fractures and a 10-year average fracture risk incidence of 1.7% for femoral neck fractures.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Osteoporosis in Men on Androgen Deprivation Therapy in Japan

Nishimoto,

Inui,

Mifune

et al. 2024

Medicina

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Background and Objectives: Androgen deprivation therapy (ADT) for prostate cancer has greatly improved treatment outcomes. As patient survival rates have increased, reports of decreased bone density and increased bone fractures as side effects of ADT have emerged. The prevalence of osteoporosis in Japanese men was 4.6%. The purpose of this study was to evaluate the effect of osteoporosis treatment in prostate cancer patients who underwent ADT in Japan. Materials and Methods: The subjects were 33 male patients who had undergone ADT for prostate cancer, who were noted to have decreased bone density. Mean age was 76.2 ± 7.7 years (64–87). Medications included vitamin D in one case, bisphosphonates (BP) in 27 cases, and denosumab in five cases. The evaluation method examined the rate of change in bone mineral density (BMD) before osteoporosis treatment and 1 year after. For comparison, a group without osteoporosis treatment intervention (n = 33) was selected, and matched for prostate cancer treatment and age. The rate of change in trabecular bone score (TBS) was also calculated. Results: The percentage changes in BMD before and 1 year after treatment were as follows: lumbar spine, 7.1 ± 5.8% in the treatment group versus −3.9 ± 4.1% in the no treatment group; femoral neck, 5.5 ± 6.2% in the treatment group versus −0.9 ± 3.9% in the no treatment group; total femur, 6.6 ± 6.4% in the treatment group versus the no treatment group which was −1.7 ± 3.2%. In all cases, there was a clear significant difference (p < 0.01). The percent change in TBS was further calculated in the same manner. There was no significant difference between the two groups: +1.7 ± 3.8% in the treated group versus +0.3 ± 4.1% in the untreated group. Conclusions: Osteoporosis treatment in Japanese patients with prostate cancer on ADT therapy was found to significantly increase BMD compared to the untreated group. BP and denosumab were found to be very effective in increasing BMD.

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Section: Discussionmentioning

confidence: 99%

Treatment of Osteoporosis in Men on Androgen Deprivation Therapy in Japan

Nishimoto,

Inui,

Mifune

et al. 2024

Medicina

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“…Although ADT is associated with increased loss of BMD, other risk factors present in patients with prostate cancer must be considered, including treatment with corticosteroids, anticonvulsants, H2 receptor antagonists, proton pump inhibitors, chronic kidney disease and a history of fragility fractures 10 . Furthermore, some men may also have pre‐existing osteopenia or osteoporosis prior to starting treatment 34 . FRAX is a useful and easily accessible tool for estimation of 10‐year major osteoporotic fracture risk that can be used in clinical practice, with or without BMD assessment, to determine the need for further evaluation such as a DEXA scan 35,36 .…”

Section: Discussionmentioning

confidence: 99%

'Prehabilitation' checklist for men with prostate cancer starting androgen deprivation therapy

Payne,

Bahl,

Kirby

et al. 2024

Trends Urol & Men's Health

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Androgen deprivation therapy (ADT) plays an important, integral role in the treatment of prostate cancer; however, it is associated with multiple metabolic and other adverse effects. Making patients aware of these prior to starting ADT and assessing any specific risks during discussions is key to optimising outcomes. A brief checklist for health care professionals to use with patients, such as the one presented here, can aid discussions and facilitate signposting to appropriate specialist services without increasing workload.

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“…In the RTOG 0518 study, which evaluated the protective effect of zoledronic acid on high-risk patients and/or those with locally advanced PC treated with RT and ADT [28], a 5-8% decrease was observed in the lumbar spine, bilateral hip, and femoral neck in bone densitometry measurements by exposing larger areas, such as the proximal femur, in the radiation fields of pelvic RT, and an increased risk of hypogonadism-induced bone loss was observed from pelvic external beam RT [6]. In a study by van Oostwaard et al, despite a lower 10-year risk of OF, there was a high prevalence of vertebral fractures in men with PC undergoing ADT, and the importance of a systematic vertebral fracture assessment with BMD and FRAX to improve identification of true incident vertebral fractures during ADT was shown [30].…”

Section: Discussionmentioning

confidence: 99%

Association of Androgen Deprivation Therapy with Osteoporotic Fracture in Patients with Prostate Cancer with Low Tumor Burden Using a Retrospective Population-Based Propensity-Score-Matched Cohort

Kim

Jeon

Bak

et al. 2023

Cancers

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This study evaluated the effect of androgen deprivation therapy (ADT) on osteoporotic fractures (OF) and its prognostic effect on overall survival in patients with localized or regional prostate cancer (PC) using the Korean National Insurance Dataset. A total of 8883 pairs of 1:1 propensity-score-matched patients with localized or regional PC were retrospectively enrolled between 2007 and 2016. All patients underwent at least 1 year of follow-up to evaluate therapeutic outcomes. Multivariate analysis was performed to determine the prognostic effect of ADT on OF. During a mean follow-up of 47.7 months, 977 (3.43%) patients developed OF, and the incidences of hip, spine, and wrist fractures were significantly different between ADT and non-ADT groups (p < 0.05). The ADT group had a significantly higher incidence of OF (hazard ratio 2.055, 95% confidence interval 1.747–2.417) than the non-ADT group (p < 0.05), and the incidence of spine/hip/wrist OF was significantly higher in the ADT group regardless of the PC stage (p < 0.05). Multivariate analysis failed to show any significant difference in overall survival between the two groups (p > 0.05). ADT resulted in a significantly higher incidence of OF among patients with localized and regional PC, but the overall survival did not differ between ADT and non-ADT groups.

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High prevalence of vertebral fractures at initiation of androgen deprivation therapy for prostate cancer

Cited by 7 publications

References 43 publications

Treatment of Osteoporosis in Men on Androgen Deprivation Therapy in Japan

Treatment of Osteoporosis in Men on Androgen Deprivation Therapy in Japan

'Prehabilitation' checklist for men with prostate cancer starting androgen deprivation therapy

Association of Androgen Deprivation Therapy with Osteoporotic Fracture in Patients with Prostate Cancer with Low Tumor Burden Using a Retrospective Population-Based Propensity-Score-Matched Cohort

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