Fracture risk in Danish men with prostate cancer: a nationwide register study.
OBJECTIVE
To assess the risk of fracture attributable to prostate cancer, and the impact of exposure to prescribed gonadotrophin-releasing hormone agonists and antiandrogens on this risk in a nationwide, population-based case-control study.


METHODS
Data from the Danish National Hospital Discharge Register, the National Bureau of Statistics, and the National Prescriptions Database were merged. The analysis covered 15 716 men aged >50 years presenting with a fracture at any hospital in Denmark in 2000, and 47 149 age-matched control men. A previous diagnosis of prostate cancer had been recorded in 1.3% of controls and 2.5% of those with a fracture.


RESULTS
Prostate cancer was associated with an increased odds ratio (95% confidence interval) for all fractures of 1.8 (1.6-2.1), for hip fractures of 3.7 (3.1-4.4), but no increased risk of vertebral fractures. The increased fracture risk became apparent early after diagnosis and remained pronounced even in long-term survivors. Androgen deprivation therapy (ADT) with an odds ratio of 1.7 (1.2-2.5; P < 0.01) and orchidectomy, at 1.7 (1.2-2.4; P < 0.01) added to the overall fracture risk. In all, 3.1% of hip fractures in Danish men aged >50 years are attributable to prostate cancer.


CONCLUSIONS
Prostate cancer, orchidectomy and the use of ADT are associated with a markedly greater risk of fractures, especially of the hip. The risk of hip fracture is not confined to the very old, neither is the risk made negligible by the excess mortality in patients with advanced prostate cancer.
Abrahamsen
Bo
B
Department of Internal Medicine and Endocrinology, Copenhagen University Hospital, Gentofte, Denmark. b.abrahamsen@physician.dk
Nielsen
Morten F
MF
Eskildsen
Peter
P
Andersen
Jens Thorup
JT
Walter
Steen
S
Brixen
Kim
K
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000009:adverse effects*; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D015519:Bone Density / Q000187:drug effects; D016022:Case-Control Studies; D003718:Denmark / Q000453:epidemiology; D050723:Fractures, Bone / Q000139:chemically induced* / Q000453:epidemiology; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy / Q000009:adverse effects; D010024:Osteoporosis / Q000139:chemically induced* / Q000453:epidemiology; D011471:Prostatic Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D012307:Risk Factors