Risk of fractures associated with treatment for benign prostate hyperplasia in men.
Treatment of benign prostate hyperplasia with α-blockers may affect blood pressure while treatment with 5-α-reductase inhibitors may affect conversion of testosterone potentially leading to osteoporosis. In our study, neither 5-α-reductase inhibitors nor α-blockers were associated with negative effects on fractures, α-blockers perhaps being associated with a limited decrease in fractures.


BACKGROUND
The objective is to study fracture risk associated with drugs for benign prostate hyperplasia. The hypotheses were that (1) α-blockers may elevate fracture risk by causing presyncope/falls and (2) 5-α-reductase inhibitors may elevate fracture risk by lowering dihydrotestosterone.


METHODS
This is a nationwide case-control study using all 9,719 male fracture patients aged ≥60 years in the year 2000 as cases and drawing 29,156 age- and gender-matched controls. The main exposure was the use of the drugs mentioned above for benign prostate hyperplasia. Confounder control included social variables, contacts to hospitals and general practitioners, alcoholism and other variables.


RESULTS
For the 5-α-reductase inhibitors, no change in overall risk of fractures was seen. No change in risk of hip, spine and forearm fractures was present. For the α-blockers, a decrease in overall risk of fractures was seen, as well as a decrease in the risk of hip and spine fractures, but only at average doses >0.5 defined daily doses per day. No decrease was seen for forearm fractures. A decreasing risk of any fracture, hip fractures and spine fractures were seen with increasing dose of α-blockers, while no such association was seen for the forearm fractures.


CONCLUSIONS
Neither the 5-α-reductase inhibitors nor α-blockers were associated with negative effects on fracture risk. A small trend towards a decrease in fracture risk may be present for the α-blockers. However, more research is needed to confirm if this trend is real.
Vestergaard
P
P
Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark. p-vest@post4.tele.dk
Rejnmark
L
L
Mosekilde
L
L
D058891:5-alpha Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005543:Forearm Injuries / Q000139:chemically induced*; D006620:Hip Fractures / Q000139:chemically induced*; D006801:Humans; D008297:Male; D011470:Prostatic Hyperplasia / Q000188:drug therapy*; D012307:Risk Factors; D016103:Spinal Fractures / Q000139:chemically induced*; D016896:Treatment Outcome
D058891:5-alpha Reductase Inhibitors; D000317:Adrenergic alpha-Antagonists