Risk of low bone mineral density in testicular germ cell cancer survivors: association with hypogonadism and treatment modality

Abstract

The cure rate of testicular cancer exceeds 95%, but testicular cancer survivors (TCS) are at increased risk of hypogonadism (HG). It has been suggested that TCS have reduced bone mineral density (BMD), but it is unclear whether this is related to HG or a direct effect of cancer therapy. The aim of this study was to evaluate whether TCS have decreased BMD, and if BMD is related to HG and/or the cancer treatment given. We investigated 91 TCS (mean age at diagnosis: 31 years; mean 9.3 years follow-up) and equal number of age matched controls (mean age at inclusion 40.3 years and 41.2 years, respectively). Total testosterone and LH were measured. BMD was determined using dual-energy X-ray absorptiometry (DXA). Low BMD (LBD) was defined as Z-score <-1. Compared to eugonadal TCS, both TCS with untreated HG (mean difference: -0.063 g/cm ; 95% CI: -0.122; -0.004 p = 0.037) and TCS receiving androgen replacement (mean difference -0.085 g/cm ; 95% CI: -0.168; -0.003; p = 0.043) presented with statistically significantly 6-8% lower hip BMD. At the spine, L1-L4, an 8% difference reached the level of statistical significance only for those with untreated HG (mean difference: -0.097 g/cm ; 95% CI: -0.179; -0.014; p = 0.022). TCS with untreated HG had significantly increased OR for spine L1-L4 LBD (OR = 4.1; 95% CI: 1.3; 13; p = 0.020). The associations between the treatment given and BMD were statistically non-significant, both with and without adjustment for HG. In conclusion, TCS with HG are at increased risk of impaired bone health. Prevention of osteoporosis should be considered as an important part in future follow up of these men.

Hypogonadism and Sexual Dysfunction in Testicular Tumor Survivors: A Systematic Review

“…The patients treated with radiotherapy did not show a significantly worse BMD compared with those who received chemotherapy or surgery alone (23). Accordingly, the 9-year-long follow-up in 91 testicular tumor survivors (mean age: 31 years) revealed a significantly 6–8% lower hip BMD in both untreated and treated hypogonadal survivors compared to eugonodal ones and a significant 8% lower spinal BMD in untreated hypogonadal compared to eugonodal survivors (40), thus suggesting the increased risk of impaired bone health in hypogonadal testicular tumor survivors. By contrast, a single study on only 39 testicular tumor (TT) patients after a follow-up time ranging from 5 to 28 years did not find abnormal BMD in patients treated with surgery alone or with chemotherapy (41).…”

High risk of hypogonadism in young male cancer survivors

“…One participant admitted to prior use of anabolic steroids (12 years earlier). Data on the association between hypogonadism and bone mineral density and the metabolic syndrome in this patient cohort have recently been published.…”

Fertility Outcomes and Sperm-DNA Parameters in Metastatic Melanoma Survivors Receiving Vemurafenib or Dabrafenib Therapy: Case Report

“…In fact, in addition to infertility, these conditions represent independent risk factors for cardiovascular disease and osteoporosis respectively. Therefore, an adequate oncological counseling to cancer patients appears as mandatory in order to correctly address the risk/benefit ratio of available adjuvant therapies (20)(21)(22)(23)(24)(25)(26)(27).…”