Androgen-deprivation-therapy-induced fractures in men with nonmetastatic prostate cancer: what do we really know?
Androgen deprivation therapy (ADT) alone or in combination with radiation therapy or other drugs is increasingly used for the treatment of localized, high-risk, or biochemical relapse of prostate cancer (PC). Bone mineral density (BMD) loss is rapid during the first year of ADT; up to 4.6% of total hip, femoral neck, and lumbar spine BMD loss has been reported in PC patients without bone metastases (nonmetastatic PC). In prospective studies, concurrent administration of a bisphosphonate or selective estrogen receptor modulator stabilized or increased BMD. Results of retrospective studies of ADT-treated patients who did not receive antiresorptive therapy have demonstrated a 21-37% increase in fracture risk. Because of the documented bone loss and increased fracture risk, patients should receive adequate counseling, monitoring, and therapy aimed at preventing or treating ADT-induced bone loss. Future studies should address the long-term impact of antiresorptive therapy on actual fracture rate and the impact on quality of life and healthcare costs.
Higano
Celestia S
CS
University of Washington, Seattle Cancer Care Alliance, Seattle, WA 98109, USA. thigano@u.washington.edu
D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects*; D004164:Diphosphonates / Q000494:pharmacology; D004967:Estrogens / Q000494:pharmacology; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D008297:Male; D009919:Orchiectomy / Q000009:adverse effects*; D015995:Prevalence; D011471:Prostatic Neoplasms / Q000628:therapy*
D000726:Androgen Antagonists; D004164:Diphosphonates; D004967:Estrogens; D007987:Gonadotropin-Releasing Hormone