Risk of Fracture after Androgen Deprivation for Prostate Cancer

TLDR

Androgen‑deprivation therapy for prostate cancer has become increasingly common over the past 15 years. This study examined whether androgen‑deprivation therapy elevates fracture risk by analyzing records of 50,613 prostate‑cancer patients from SEER‑Medicare between 1992 and 1997. Using a retrospective cohort design, the authors compared fracture incidence and hospitalization‑related fractures between patients who received ADT and those who did not, applying Cox proportional‑hazards models adjusted for patient, tumor, and prior fracture or osteoporosis status. ADT was associated with a higher five‑year fracture rate (19.4% vs 12.6%) and a dose‑dependent increase in fracture risk, confirming that androgen‑deprivation therapy elevates fracture risk in prostate‑cancer survivors.

Abstract

The use of androgen-deprivation therapy for prostate cancer has increased substantially over the past 15 years. This treatment is associated with a loss of bone-mineral density, but the risk of fracture after androgen-deprivation therapy has not been well studied.We studied the records of 50,613 men who were listed in the linked database of the Surveillance, Epidemiology, and End Results program and Medicare as having received a diagnosis of prostate cancer in the period from 1992 through 1997. The primary outcomes were the occurrence of any fracture and the occurrence of a fracture resulting in hospitalization. Cox proportional-hazards analyses were adjusted for characteristics of the patients and the cancer, other cancer treatment received, and the occurrence of a fracture or the diagnosis of osteoporosis during the 12 months preceding the diagnosis of cancer.Of men surviving at least five years after diagnosis, 19.4 percent of those who received androgen-deprivation therapy had a fracture, as compared with 12.6 percent of those not receiving androgen-deprivation therapy (P<0.001). In the Cox proportional-hazards analyses, adjusted for characteristics of the patient and the tumor, there was a statistically significant relation between the number of doses of gonadotropin-releasing hormone received during the 12 months after diagnosis and the subsequent risk of fracture.Androgen-deprivation therapy for prostate cancer increases the risk of fracture.