Androgen deprivation therapy and fracture risk in Chinese patients with prostate carcinoma.
OBJECTIVE
Androgen deprivation therapy (ADT) increases fracture risk in men with carcinoma of the prostate, but little is known about the fracture risk for different types of ADT. We studied the fracture risk amongst Chinese patients with carcinoma of the prostate prescribed different ADT regimens.


METHODS
This was a single-centered observational study that involved 741 patients with carcinoma of the prostate from January 2001 to December 2011.


RESULTS
After a median follow-up of 5 years, 71.7% of the study cohort received ADT and the incidence rate of fracture was 8.1%. Multivariable Cox regression analysis revealed that use of ADT was significantly associated with risk of incident fracture (Hazard Ratio [HR] 3.60; 95% Confidence Interval [95% CI] 1.41-9.23; p = 0.008), together with aged >75 years and type 2 diabetes. Compared with no ADT, all three types of ADT were independently associated with the risk of incident fracture: anti-androgen monotherapy (HR 4.47; 95% CI 1.47-13.7; p = 0.009), bilateral orchiectomy ± anti-androgens (HR 4.01; 95% CI 1.46-11.1; p = 0.007) and luteinizing hormone-releasing hormone agonists ± anti-androgens (HR 3.16; 95% CI 1.18-8.43; p = 0.022). However, there was no significant difference in the relative risks among the three types of ADT.


CONCLUSIONS
Fracture risk increases among all types of ADT. Clinicians should take into account the risk-benefit ratio when prescribing ADT, especially in elderly patients with type 2 diabetes.
Division of Endocrinology & Metabolism, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, Hong Kong.
Chi-Ho
CH
Lee
Division of Cardiology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR; Hong Kong.|Cardiology Department, The Second People's Hospital of Chengdu, Chengdu, China.
Gang
G
Huang
Division of Cardiology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR; Hong Kong.
Pak-Hei
PH
Chan
Division of Cardiology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR; Hong Kong.
Jojo
J
Hai
Division of Endocrinology & Metabolism, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, Hong Kong.
Chun-Yip
CY
Yeung
Division of Endocrinology & Metabolism, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, Hong Kong.
Carol Ho-Yi
CH
Fong
Division of Endocrinology & Metabolism, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, Hong Kong.
Yu-Cho
YC
Woo
Division of Urology, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR; Hong Kong.
Kwan Lun
KL
Ho
Division of Urology, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR; Hong Kong.
Ming-Kwong
MK
Yiu
Department of Orthopedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, Hong Kong.
Frankie
F
Leung
Department of Orthopedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, Hong Kong.
Tak-Wing
TW
Lau
Division of Cardiology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR; Hong Kong.
Hung-Fat
HF
Tse
Division of Endocrinology & Metabolism, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, Hong Kong.
Karen Siu-Ling
KS
Lam
Division of Cardiology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR; Hong Kong.
Chung-Wah
CW
Siu
D000368:Aged; D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D011471:Prostatic Neoplasms / Q000150:complications* / Q000188:drug therapy; D012189:Retrospective Studies; D018570:Risk Assessment
D000726:Androgen Antagonists