title: Osteoporotic fractures in patients with untreated hyperprolactinemia vs. those taking dopamine agonists: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Hyperprolactinemia is associated with bone fragility. Traditionally attributed to prolactin-induced hypogonadism, recent studies have identified increased fracture rates independent of gonadal function.
  
  
  METHODS
  We performed a systematic review to identify studies assessing fracture risk in patients with untreated hyperprolactinemia compared to those on dopamine agonists. MEDLINE, EMBASE, Cochrane, Web of Science and BIOSIS Previews databases were searched from inception to December 2013 for studies of hyperprolactinemia with fractures as an outcome. Two authors independently performed title and abstract searches, full-text searches, data abstraction, and quality assessment. A summary odds ratio (OR) was calculated using a random effects model.
  
  
  RESULTS
  Of the 197 articles identified, 2 met inclusion criteria. Both cross-sectional studies examined cabergoline use (or non-use) in patients with prolactin-secreting adenomas, with vertebral fractures as the primary outcome. For women, vertebral fractures were identified in 46% of untreated patients, vs. 20% of patients on cabergoline (OR: 0.29, 95% CI: 0.10-0.78). For men, the results were 67% in untreated, vs. 26% in cabergoline treated patients (OR: 0.18, CI: 0.03-0.94), with no difference between gonadal and hypogonadal men (p=0.8). Combining studies gave a summary odds ratio of 0.25 (CI: 0.11-0.59), I2=0%.
  
  
  CONCLUSIONS
  In the limited studies available, fracture prevalence was increased in patients with untreated hyperprolactinemia compared to those on treatment, independent of gonadal function. Further studies are needed to clarify if post-menopausal women, or high-risk men, with no other indication for treatment, should be on dopamine agonists to decrease fracture risk.
authors.affiliation: Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London Ontario, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: D'Sylva
authors.affiliation: Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London Ontario, Canada.
authors.forename: Tayyab
authors.initials: T
authors.lastname: Khan
authors.affiliation: Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London Ontario, Canada.
authors.forename: Stan
authors.initials: S
authors.lastname: Van Uum
authors.affiliation: Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London Ontario, Canada.
authors.forename: Lisa-Ann
authors.initials: LA
authors.lastname: Fraser
mesh_terms: D000077465:Cabergoline; D018491:Dopamine Agonists / Q000627:therapeutic use*; D004873:Ergolines / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006966:Hyperprolactinemia / Q000188:drug therapy / Q000453:epidemiology*; D007006:Hypogonadism / Q000453:epidemiology*; D008297:Male; D016017:Odds Ratio; D058866:Osteoporotic Fractures / Q000453:epidemiology*; D010911:Pituitary Neoplasms / Q000188:drug therapy / Q000453:epidemiology*; D015995:Prevalence; D015175:Prolactinoma / Q000188:drug therapy / Q000453:epidemiology*; D012737:Sex Factors; D016103:Spinal Fractures / Q000453:epidemiology*
chemical_list: D018491:Dopamine Agonists; D004873:Ergolines; D000077465:Cabergoline