Elsevier

Urology

Volume 69, Issue 3, March 2007, Pages 500-504
Urology

Adult urology
Prevalence of Osteoporosis During Long-Term Androgen Deprivation Therapy in Patients with Prostate Cancer

https://doi.org/10.1016/j.urology.2006.11.002Get rights and content

Objectives

To know the prevalence of osteoporosis in patients with prostate cancer according to the duration of androgen deprivation therapy (ADT).

Methods

Dual energy x-ray absorptiometry was used to assess the bone mineral density (BMD) at the lumbar spine, femoral neck, Ward’s triangle, trochanter, and total hip in 390 patients free of bone metastases. Osteoporosis was diagnosed if a T-score of less than 2.5 was detected at any measurement site. A subset of 124 patients were hormone naive at BMD testing, and 112 had undergone ADT for 2 years, 61 for 4 years, 37 for 6 years, 35 for 8 years, and 21 for 10 years or longer.

Results

The osteoporosis rate was 35.4% in hormone-naive patients, 42.9% after 2 years of ADT, 49.2% after 4 years, 59.5% after 6 years, 65.7% after 8 years, and 80.6% after 10 or more years. Conversely, the rate of normal BMD decreased from 19.4% in hormone-naive patients to 17.8% after 2 years of ADT, 16.4% after 4 years, 10.8% after 6 years, 5.7% after 8 years, and 0% after 10 or more years of ADT.

Conclusions

The prevalence of osteoporosis seemed high in hormone-naive patients with prostate cancer, and it increased to more than 80% after 10 years of ADT. Because of the increased risk of bone fractures in those patients, clinicians should be aware of the impact of ADT on BMD to prevent bone mass loss.

Section snippets

Study Group

This was a cross-sectional study that included 390 patients with PCa who were free of bone metastases. PCa was staged at diagnosis as localized in 185 patients (47.4%), locally advanced in 161 (41.3%), and metastatic lymph node disease in 44 (11.3%). The primary treatment of PCa was radical prostatectomy in 157 patients (40.3%) and ADT in 233 (59.7%). Other characteristics of the study population are summarized in Table 1. Patients treated with radiotherapy, patients with positive bone

Results

The prevalence of osteoporosis increased progressively during ADT, reaching almost 50% after 4 years of ADT and more than 80% after 10 years. In contrast, it affected 35.4% of hormone-naive patients with PCa. Conversely, a normal BMD was detected in 19.4% of hormone-naive patients and decreased progressively during ADT. After 10 years of ADT, none of the patients had a normal BMD. The prevalence of osteoporosis, osteopenia, and normal BMD according to the WHO criteria is presented in Figure 1.

Comment

In the present report, we observed a progressive increase in the prevalence of osteoporosis in androgen-suppressed patients with PCa. The prevalence of osteoporosis reached 80% after 10 years of ADT. In addition, the bone mass loss and prevalence of osteoporosis varied according to the BMD site of measurement. Both parameters increased with a longer duration of ADT at all BMD measurement sites. In addition, a high rate of osteoporosis was observed in the hormone-naive patients with PCa.

The

Conclusions

The prevalence of osteoporosis in hormone-naive patients with PCa seems to be high, and it increases progressively with ADT. After 10 years of ADT, more than 80% of patients were at a high risk of osteoporotic fractures. Because the prevalence of osteoporosis increases during ADT, preventive measures are recommended. Additionally, a basal BMD measurement might be useful to identify patients at a greater risk of bone loss who would be candidates for osteoporosis treatment.

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