Incidence of bone fracture in patients receiving luteinizing hormone‐releasing hormone agonists for prostate cancer

Hatano, Takashi; Oishi, Yukihiko; Furuta, Akira; Iwamuro, Shinya; Tashiro, Kojiro

doi:10.1046/j.1464-410x.2000.00774.x

Cited by 146 publications

(61 citation statements)

References 9 publications

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“…21 Hatano et al, in a similar retrospective study over 5 years, reported a 6% incidence of fractures in men treated with ADT for Ͼ 6 months. 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.…”

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

confidence: 99%

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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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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.…”

mentioning

confidence: 99%

Osteoporosis in men with prostate carcinoma receiving androgen‐deprivation therapy

Diamond

Higano

Smith

et al. 2004

Cancer

242

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“…10,11 It is likely that this is related to the iatrogenic hypogonadism and resulting low serum testosterone concentrations.…”

Section: Discussionmentioning

confidence: 99%

“…9 Bone loss and fractures have been reported in these situations. 10,11 The side effect profile of LHRH agonists reflects the hypogonadal state that is produced. There is reduction in muscle mass, libido and potency as well as hot flushes, gynaecomastia, fatigue and weight gain, although the effect on skeletal homeostasis is less well known.…”

Section: Introductionmentioning

confidence: 99%

Bone loss associated with the use of LHRH agonists in prostate cancer

Peters¹,

Fairney

Kyd

et al. 2001

Prostate Cancer Prostatic Dis

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Hypogonadism is a recognised cause of osteoporosis in men. When patients with advanced prostate cancer are treated with luteinising hormone releasing hormone (LHRH) agonist analogues their circulating testosterone levels decline and these patients may develop fractures.We have undertaken a cross-sectional study on a cohort of patients treated with goserelin (n ¼ 41) and compared their bone density and bone turnover with patients with prostate cancer not on goserelin and elderly patients living in the community.There was no difference in bone density between the patients on treatment and those living in the community and there was a similar incidence of osteoporosis (50 and 42%, respectively). The bone marker measurements were higher in the treated patients: urine N-telopeptide (NTX) 80.1 (9) (mean (s.e.)) BCE/mmol, compared to 30.1 (2.9), P < 0.001 in elderly patients; and bone alkaline phosphatase 41.9 (6.1) u/l in treated patients and 20.7 (1.5) in untreated prostate cancer patients, P < 0.002. Patients on treatment with radionuclide scan evidence of metastases did not have higher bone marker values than those with negative scans.As increased bone turnover and low bone density are associated with enhanced risk of osteoporotic fractures, we suggest that patients on LHRH agonist analogues should receive advice and possibly anti-bone resorptive treatment with bisphosphonates to prevent further bone loss and fractures. Prostate Cancer and Prostatic Diseases (2001) 4, 161-166.

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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: 97%

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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Incidence of bone fracture in patients receiving luteinizing hormone‐releasing hormone agonists for prostate cancer

Cited by 146 publications

References 9 publications

Osteoporosis in men with prostate carcinoma receiving androgen‐deprivation therapy

Osteoporosis in men with prostate carcinoma receiving androgen‐deprivation therapy

Bone loss associated with the use of LHRH agonists in prostate cancer

Osteoporosis and prostate cancer

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