Osteoporosis and spinal fractures in men with prostate cancer: risk factors and effects of androgen deprivation therapy.
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.
Diamond
Terrence H
TH
Department of Endocrinology, St. George Hospital Campus, University of New South Wales, Kogarah, Sydney, Australia. terrydiamond@optushome.com.au
Bucci
Joseph
J
Kersley
John H
JH
Aslan
Peter
P
Lynch
William B
WB
Bryant
Carl
C
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
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