Factors affecting bone mineral density in patients with prostate carcinoma before and after orchidectomy

Abstract

BACKGROUNDOrchidectomy is an accepted form of androgen‐deprivation therapy (ADT) for prostate carcinoma. Osteoporosis is common in elderly individuals and is accelerated by ADT. The authors studied changes in bone mineral density (BMD) after ADT and factors that affected those changes.METHODSFifty patients with prostatic adenocarcinoma who opted to undergo orchidectomy were studied prospectively. All patients completed 6 months of follow‐up, and 20 of those patients completed 12 months of follow‐up. Patients' age, weight, height, body mass index (BMI), physical activity, addiction (smoking, alcohol), dietary calcium intake, and lactose tolerance status were noted. Lumbar spinal (L1–L3) trabecular BMD was measured with quantitative computed tomography (QCT) at baseline and every 6 months for 1 year and was compared with preoperative values. The effects of various patient characteristics on preoperative BMD and changes in BMD also were analyzed.RESULTSThe mean ± standard deviation (SD) age of the patients was 69.5 ± 8.1 years, BMI was 23.5 ± 3.9 kg/m2, dietary calcium intake was 1066.1 ± 443.3 mg per day. Thirty‐eight percent of patients were lactose intolerant. Sixty‐two percent of patients were in the light weight‐bearing activity group. The mean ± SD preoperative BMD was 119.2 ± 34.9 mg/cc, with T‐scores of − 1.77 ± 1.22 and Z‐scores of 0.43 ± 1.27. A decrease in BMD during the first 6 months (≈ 13%) was statistically significant (P = 0.0001) and continued further during next 6 months (BMD loss of ≈ 18% at 12 months). Patients with osteoporosis, as defined by T‐scores ≤ − 2.5, increased from 24% at baseline to 48% at 6 months. Nonsmokers, nonalcoholics, patients with higher physical activity, and patients with a BMI > 25 kg/m2 had statistically significant higher BMD compared with their counterparts (P < 0.05). Body weight < 60 kg and BMI < 25 kg/m2 were significant risk factors for loss of BMD (P < 0.05). Dietary calcium had a discernible but statistically insignificant effect on BMD (P = 0.16). Lactose intolerance had no significant effect on BMD or bone loss.CONCLUSIONSOsteoporosis was common in the population affected by prostate carcinoma. Orchidectomy led to accelerated bone loss. Periodic measurement of BMD after ADT would help in the early detection of osteoporosis. Maintenance of high BMI, weight‐bearing physical activity, avoidance of alcohol and smoking, and possibly high dietary calcium intake help in maintaining bone mass. Cancer 2005. © 2005 American Cancer Society.

A Prospective Study to Evaluate the Effects of Sodium Alendronate (An Oral Bisphosphonate) on Bone Mineral Density (Bmd) in Patients With Carcinoma Prostate Treated With Hormonal Manipulation

“…At 6 months, the average BMD at lumbar spine decreased by 1.09% in treated population, which is not statistically significant. This fall of average BMD at lumbar vertebra by 1.09% at 6 months is much lower as compared to 12% fall in a similar population of untreated patients at the same site at 6 months as reported by Mayank et al 18 The incidence of side effects with once weekly alendronate is low and gastrointestinal side effects are comparable with that of placebo. 25 In our study one patient complained of upper gastrointestinal discomfort, which on subsequent evaluation was found to be due to gall stone disease.…”

“…Osteopenia or osteoporosis develops progressively 13 in a number of patients and can be a cause of significant mortality, 17 primarily because of incidence of hip fractures. In an Indian study, Mayank et al 18 reported 12% and 18% bone loss at 6 and 12 months respectively after orchidectomy.…”

Bone health in prostate cancer patients receiving androgen-deprivation therapy: the role of bisphosphonates

“…1,10,[12][13][14][15][16] The three risk factors that have been reliably identified in patients with locally advanced disease are older age, low body mass index and a long duration of ADT. In metastatic prostate cancer, the only reliable risk factor is elevated levels of deoxypyridinoline.…”

Managing Complications of Androgen Deprivation Therapy for Prostate Cancer

“…The authors estimate that over 3000 fractures per year can be attributed to the use of ADT. Just as alarming are recent data that showed that patients begin having effects on BMD with LHRH agonist use in as little as 9 months of therapy and as quickly as 6 months after orchiectomy [35]. It seems that the majority of the bone loss occurs within the first year and then continues at a slower pace.…”