Skeletal Fracture Associated With Androgen Suppression Induced Osteoporosis: The Clinical Incidence and Risk Factors for Patients With Prostate Cancer

Oefelein, Michael G.; Ricchuiti, Vincent; Conrad, William; Seftel, Allen D.; Bodner, Donald R.; Goldman, Howard B.; Resnick, Martin I.

doi:10.1016/s0022-5347(05)65661-3

Cited by 181 publications

(95 citation statements)

References 15 publications

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“…8,28 Furthermore, radiotherapy may damage the structure of bone and cause osteoporosis. 25,30,31 Finally, the development of osteoporosis is associated with smoking and physical inactivity. 32 In our study, the survivors of gynaecological cancer smoke more and are less physical active, contributing to the increased risk of osteoporosis among gynaecological cancer survivors.…”

Section: Discussionmentioning

confidence: 99%

Self‐reported health and use of health care services in long‐term cancer survivors

Nord

Mykletun

Thorsen

et al. 2004

Intl Journal of Cancer

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Owing to an increasing number of long-term cancer survivors, the use of health care services and somatic health problems were compared between cancer survivors and a noncancer population. Data from the Nord-Trøndelag Health Survey 2 (HUNT 2, 1995-1997) was merged with the Cancer Registry of Norway. Six cancer subgroups were constructed with diagnosis 5 years prior HUNT 2: testicular cancer (n‫؍‬ 59), colorectal cancer (n‫؍‬ 175), prostate cancer (n‫؍‬ 87), breast cancer (n‫؍‬ 258), gynaecological cancer (n‫؍‬ 153) and lymphoma/leukaemia (n‫؍‬ 83). For each cancer survivor 3 matched noncancer controls were selected from the HUNT 2 survey. The prevalence of common health problems, use of health care services and unfavourably life style parameters were compared between the 2 groups. Cancer survivors used health care services and received social welfare benefits more often than the controls. There was an increased risk of perceiving poor health after a history of cancer. In the recent decade, the incidence of most malignancies has increased, as well as 5-year survival rates in both men and women. 1 During 1992-1996, the relative overall 5-year survival rate for all cancer patients in Norway was, respectively, 50% in males and 58%; in females compared to 25% in males and 38%; in females for the period 1957-1961. In 1999, a total of 83,636 cancer survivors with an at-least 5-year survival were alive in Norway. 1 These figures have in the last few years led to a paradigm shift: cancer should not only be considered an acute or terminal event but should likewise be viewed as a chronic condition. Quality of life and long-term effects after cancer therapy have therefore become important outcome parameters to be considered by oncologists, cancer surgeons and primary health care officers.Cancer represents a heterogeneous group of diagnoses where treatment and aetiology are far from uniform. The cancer itself and its treatment may affect the long-term health of cancer survivors at various degrees, causing adverse health conditions, which differ from those observed in the age-matched noncancer population. The recognition of common health problems reducing the overall well being among cancer survivors is of importance in order to identify these individuals' specific needs when presented to the health care service. Furthermore the recognition of long-term effects of treatment may lead to reconsideration and eventual modification of current treatment strategies.Several reports have focused on long-term medical effects after treatment for childhood cancer as well as adulthood cancer and have described specific health problems related to different treatment modalities. 2,3,4 -9 Beside causing chronic health conditions, cancer and its treatment increase the risk of secondary malignancies. 10 -13 Owing to the increased risk of developing secondary tumours and chronic diseases after treatment for malignancies, cancer survivors represent an important target population for health promotion interventions. Few studies regarding long-te...

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Section: Discussionmentioning

confidence: 99%

Self‐reported health and use of health care services in long‐term cancer survivors

Nord

Mykletun

Thorsen

et al. 2004

Intl Journal of Cancer

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“…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. 23 However, careful scrutiny of their data suggest that only 9 fractures could be attributed strictly to ADT. The duration of ADT (P ϭ 0.001), body mass index (P ϭ 0.018), and body weight (P ϭ 0.048) were the most important determinants of fracture risk in their study.…”

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

confidence: 99%

“…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.…”

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confidence: 99%

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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“…In a second study, 9% of 224 men treated with an LHRH agonist had a fracture over a median follow-up of 22 months; seven of these men had fractures resulting from osteoporosis, eight men from trauma, and five of mixed aetiology (Townsend et al, 1997). In a third study of 218 men, 6% had an osteoporotic fracture during 6 or more months treatment with anti-androgen therapy (Hatano et al, 2000); in a fourth study, 20% of 181 men treated for 10 years had osteoporotic fractures (Oefelein et al, 2001). Fracture rates were described in 429 men with prostate cancer treated by bilateral orchiectomy.…”

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confidence: 94%

Osteoporosis and prostate cancer

Dhillon

Waxman

2003

Br J Cancer

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Prostate cancer has just become the most commonly registered cancer of males in the United Kingdom, overtaking lung cancer in the registration sweepstakes, and is the second most common cause of male cancer deaths. Deaths have trebled over the last 30 years, plateauing in the mid-1990s but recently increasing again (Office for National Statistics, 2001).Locally advanced and metastatic prostate cancer is treated with antiandrogens and the importance of the side effects of treatment have become more significant as the incidence of this malignancy has increased. These side effects from treatment range from hot flushes, impotence, breast tenderness and enlargement, and diarrhoea to the physically more significant side effects, which include anaemia, loss of muscle bulk, neurological dysfunction, and osteoporosis. All of these side effects occur as a consequence of androgen deficiency. We would argue that the development of osteoporosis is the most important of these side effects and that we need to be more proactive in our management of this condition.The risk of osteoporotic fracture as a consequence of antiandrogen therapy has been described in five studies. In a group of 235 patients with prostate cancer, the cumulative risk of fracture at 7 years was 28% in 59 castrated men and 1% in 176 men treated with a GnRH agonist (Daniell, 1997). In a second study, 9% of 224 men treated with an LHRH agonist had a fracture over a median follow-up of 22 months; seven of these men had fractures resulting from osteoporosis, eight men from trauma, and five of mixed aetiology (Townsend et al, 1997). In a third study of 218 men, 6% had an osteoporotic fracture during 6 or more months treatment with anti-androgen therapy (Hatano et al, 2000); in a fourth study, 20% of 181 men treated for 10 years had osteoporotic fractures (Oefelein et al, 2001). Fracture rates were described in 429 men with prostate cancer treated by bilateral orchiectomy. There were 267 fractures in 161 men. The increased risk due to osteoporosis was reported as a standard incidence ratio of 3.50 (95% CI 2.71 -4.43) (Melton et al, 2003).The increased risk of fracture in these men is due to accelerated loss of bone mineral density and is of early onset. Decreases of 6.6% at the lumbar spine have been seen only after 6 months of treatment and decreases of 6% at the femoral neck after 18 months treatment (Diamond et al, 1998). In a French study, changes in bone mineral density were evaluated in 12 men with prostate cancer treated with triptorelin. Men with metastases, radiographic evidence of osteoporosis, or pre-existing conditions associated with accelerated bone loss were excluded from the study. Bone mineral density was measured at baseline, 6, 12, and 18 months. Bone mineral density of the lumbar spine and femoral neck tended to decrease from month 6, but only reached statistical significance at 18 months (Maillefert et al, 1999). In an American study, changes in bone mineral density were evaluated in 26 men with prostate cancer treated by orchiectomy or with ...

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Skeletal Fracture Associated With Androgen Suppression Induced Osteoporosis: The Clinical Incidence and Risk Factors for Patients With Prostate Cancer

Cited by 181 publications

References 15 publications

Self‐reported health and use of health care services in long‐term cancer survivors

Self‐reported health and use of health care services in long‐term cancer survivors

Osteoporosis in men with prostate carcinoma receiving androgen‐deprivation therapy

Osteoporosis and prostate cancer

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