title: Osteoporosis and spinal fractures in men with prostate cancer: risk factors and effects of androgen deprivation therapy.
abstract: OBJECTIVE
  We determined the risk factors for osteoporosis and spinal fractures in men with prostate cancer receiving androgen deprivation therapy.
  
  
  METHODS
  We performed a retrospective analysis of 87 consecutive men with prostate cancer receiving androgen deprivation therapy referred for evaluation of osteoporosis. Data were comprised of lateral thoracolumbar radiographs, bone densitometry, serum biochemistry and a detailed assessment of osteoporotic risk factors. Multivariate regression analysis was used to determine the major risk factors for osteoporosis and spinal fractures.
  
  
  RESULTS
  There were 38 (44%) men who were 74.5 years old with radiographic evidence of spinal fractures. They had an initial mean prostate specific antigen of 52.8 ng/ml and had received androgen deprivation therapy for a mean of 39.6 months (95% confidence interval 28.7 to 50.4). Mean spinal (quantitative computerized tomography t-score -4.2) and femoral neck bone mineral densities (dual energy x-ray absorptiometry t-score -2.1) were significantly lower than in men without spinal fractures (p < 0.001 for all measurements). In the regression analysis the duration of androgen deprivation therapy (p = 0.002), serum 25-hydroxyvitamin D levels (p = 0.003) and a history of alcohol excess (defined as more than 4 standard drinks daily, p = 0.04) were the main determinants of spinal fractures.
  
  
  CONCLUSIONS
  Prolonged androgen deprivation therapy, low serum 25-hydroxyvitamin D levels and a history of alcohol excess are important risk factors for osteoporosis and spinal fractures in men with prostate cancer.
authors.affiliation: Department of Endocrinology, St. George Hospital Campus, University of New South Wales, Kogarah, Sydney, Australia. terrydiamond@optushome.com.au
authors.forename: Terrence H
authors.initials: TH
authors.lastname: Diamond
authors.forename: Joseph
authors.initials: J
authors.lastname: Bucci
authors.forename: John H
authors.initials: JH
authors.lastname: Kersley
authors.forename: Peter
authors.initials: P
authors.lastname: Aslan
authors.forename: William B
authors.initials: WB
authors.lastname: Lynch
authors.forename: Carl
authors.initials: C
authors.lastname: Bryant
mesh_terms: D000368:Aged; D000428:Alcohol Drinking; D000726:Androgen Antagonists / Q000627:therapeutic use; D000813:Anilides / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D015897:Comorbidity; D005485:Flutamide / Q000627:therapeutic use; D017273:Goserelin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009570:Nitriles; D010024:Osteoporosis / Q000453:epidemiology*; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016103:Spinal Fractures / Q000453:epidemiology*; D013997:Time Factors; D014105:Tosyl Compounds; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000726:Androgen Antagonists; D000813:Anilides; D018931:Antineoplastic Agents, Hormonal; D009570:Nitriles; D014105:Tosyl Compounds; D017273:Goserelin; D014807:Vitamin D; D005485:Flutamide; C053541:bicalutamide; C104450:25-hydroxyvitamin D