Risk of fracture after androgen deprivation for prostate cancer.
BACKGROUND
The use of androgen-deprivation therapy for prostate cancer has increased substantially over the past 15 years. This treatment is associated with a loss of bone-mineral density, but the risk of fracture after androgen-deprivation therapy has not been well studied.


METHODS
We studied the records of 50,613 men who were listed in the linked database of the Surveillance, Epidemiology, and End Results program and Medicare as having received a diagnosis of prostate cancer in the period from 1992 through 1997. The primary outcomes were the occurrence of any fracture and the occurrence of a fracture resulting in hospitalization. Cox proportional-hazards analyses were adjusted for characteristics of the patients and the cancer, other cancer treatment received, and the occurrence of a fracture or the diagnosis of osteoporosis during the 12 months preceding the diagnosis of cancer.


RESULTS
Of men surviving at least five years after diagnosis, 19.4 percent of those who received androgen-deprivation therapy had a fracture, as compared with 12.6 percent of those not receiving androgen-deprivation therapy (P<0.001). In the Cox proportional-hazards analyses, adjusted for characteristics of the patient and the tumor, there was a statistically significant relation between the number of doses of gonadotropin-releasing hormone received during the 12 months after diagnosis and the subsequent risk of fracture.


CONCLUSIONS
Androgen-deprivation therapy for prostate cancer increases the risk of fracture.
Shahinian
Vahakn B
VB
Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0562, USA. vbshahin@utmb.edu
Kuo
Yong-Fang
YF
Freeman
Jean L
JL
Goodwin
James S
JS
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D050723:Fractures, Bone / Q000209:etiology*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D008297:Male; D009919:Orchiectomy / Q000009:adverse effects*; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D012306:Risk
D000726:Androgen Antagonists; D007987:Gonadotropin-Releasing Hormone