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Bone mineral density changes on androgen deprivation therapy for prostate cancer and response to antiresorptive therapy

Abstract

Androgen deprivation therapy improves survival of patients with prostate cancer and leads to hypogonadal state. Gonadal hormones are essential for skeletal integrity and hypogonadism constitutes a major risk factor for osteoporosis. To examine the bone loss secondary to androgen deprivation therapy, we reviewed the bone mineral density (BMD) studies of 152 patients with prostate cancer with mean duration of androgen deprivation therapy of 58 months. Among them 55 subjects had follow-up BMD measurement at 12–15 months with 39 of them on antiresorptive therapy. Osteoporosis was noted at least at one site in 92 (60.5%), among which 74 (48.7%) had changes at hip with the more prominent changes at ward's triangle, 18 (11.8%) at other sites. Osteopenia was present in 37 (24%) and only 17 (11%) were normal. The duration of antiandrogen therapy did not correlate with the degree of bone loss. Significant in improvement in the BMD is noted at 12–15month follow-up on antiresorptive therapy. We conclude that men treated with androgen deprivation therapy are at risk for bone loss and should have BMD measured at the time of initiation of androgen deprivation therapy and periodically.

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References

  1. Cancer Facts and Figures 2005. American Cancer Society 2005.

  2. Ries LAG, Eisner MP, Kosary CL, Hankey BF, Miller BA, Clegg L, Mariotto A, Feuer EJ, Edwards BK (eds.) SEER Cancer Statistics Review, 1975–2002. National Cancer Institute: Bethesda, MD. http://seer.cancer.gov/csr/1975_2000, based on November 2004 SEER data submission, posted to the SEER web site 2005.

  3. Patterson SG, Balducci L, Pow-Sang JM . Controversies surrounding androgen deprivation for prostate cancer. Cancer Control 2002; 9: 315–325.

    Article  Google Scholar 

  4. The Leuprolide Study Group. Leuprolide versus diethylstilbestrol for metastatic prostate cancer. The Leuprolide Study Group. N Engl J Med 1984; 311: 1281–1286.

  5. Soloway MS, Chodak G, Vogelzang NJ, Block NL, Schellhammer PF, Smith Jr JA et al. Zoladex versus orchiectomy in treatment of advanced prostate cancer: a randomized trial. Zoladex Prostate Study Group. Urology 1991; 37: 46–51.

    Article  CAS  Google Scholar 

  6. Seeman E, Tsalamandris C, Bass S, Pearce G . Present and future of osteoporosis therapy. Bone 1995; 17: 23S–29S.

    Article  CAS  Google Scholar 

  7. Melton III LJ, Alothman KI, Khosla S, Achenbach SJ, Oberg AL, Zincke H . Fracture risk following bilateral orchiectomy. J Urol 2003; 169: 1747–1750.

    Article  Google Scholar 

  8. Oefelein MG, Ricchuiti V, Conrad W, Seftel A, Bodner D, Goldman H et al. Skeletal fracture associated with androgen suppression induced osteoporosis: the clinical incidence and risk factors for patients with prostate cancer. J Urol 2001; 166: 1724–1728.

    Article  CAS  Google Scholar 

  9. Hatano T, Oishi Y, Furuta A, Iwamuro S, Tashiro K . Incidence of bone fracture in patients receiving luteinizing hormone-releasing hormone agonists for prostate cancer. BJU Int 2000; 86: 449–452.

    Article  CAS  Google Scholar 

  10. Orwoll E, Ettinger M, Weiss S, Miller P, Kendler D, Graham J et al. Alendronate for the treatment of osteoporosis in men. N Engl J Med 2000; 343: 604–610.

    Article  CAS  Google Scholar 

  11. Looker AC, Johnston Jr CC, Wahner HW, Dunn WL, Calvo MS, Harris TB et al. Prevalence of low femoral bone density in older US women from NHANES III. J Bone Miner Res 1995; 10: 796–802.

    Article  CAS  Google Scholar 

  12. Nelson HD, Helfand M, Woolf SH, Allan JD . Screening for postmenopausal osteoporosis: a review of evidence for the US Preventive Services Task Force. Ann Intern Med 2002; 137: 529–541.

    Article  Google Scholar 

  13. Bjarnason K, Hassager C, Ravn P, Christiansen C . Early postmenopausal diminution of forearm and spinal bone mineral density: a cross-sectional study. Osteoporos Int 1995; 5: 35–38.

    Article  CAS  Google Scholar 

  14. Pouilles JM, Tremollieres F, Ribot C . Vertebral bone loss in perimenopause. Results of a 7-year longitudinal study. Presse Med 1996; 25: 277–280.

    CAS  PubMed  Google Scholar 

  15. Orwoll ES, Oviatt SK, McClung MR, Deftos LJ, Sexton G . The rate of bone mineral loss in normal men and the effects of calcium and cholecalciferol supplementation. Ann Intern Med 1990; 112: 29–34.

    Article  CAS  Google Scholar 

  16. Daniell HW, Dunn SR, Ferguson DW, Lomas G, Niazi Z, Stratte PT . Progressive osteoporosis during androgen deprivation therapy for prostate cancer. J Urol 2000; 163: 181–186.

    Article  CAS  Google Scholar 

  17. Diamond TH, Higano CS, Smith MR, Guise TA, Singer FR . Osteoporosis in men with prostate carcinoma receiving androgen-deprivation therapy: recommendations for diagnosis and therapies. Cancer 2004; 100: 892–899.

    Article  Google Scholar 

  18. Wei JT, Gross M, Jaffe CA, Gravlin K, Lahaie M, Faerber GJ et al. Androgen deprivation therapy for prostate cancer results in significant loss of bone density. Urology 1999; 54: 607–611.

    Article  CAS  Google Scholar 

  19. Mittan D, Lee S, Miller E, Perez RC, Basler JW, Bruder JM . Bone loss following hypogonadism in men with prostate cancer treated with GnRH analogs. J Clin Endocrinol Metab 2002; 87: 3656–3661.

    Article  CAS  Google Scholar 

  20. Chang SS . Exploring the effects of luteinizing hormone-releasing hormone agonist therapy on bone health: implications in the management of prostate cancer. Urology 2003; 62: 29–35.

    Article  Google Scholar 

  21. Townsend MF, Sanders WH, Northway RO, Graham Jr SD . Bone fractures associated with luteinizing hormone-releasing hormone agonists used in the treatment of prostate carcinoma. Cancer 1997; 79: 545–550.

    Article  CAS  Google Scholar 

  22. Melton III LJ, Atkinson EJ, O'Connor MK, O'Fallon WM, Riggs BL . Bone density and fracture risk in men. J Bone Miner Res 1998; 13: 1915–1923.

    Article  Google Scholar 

  23. Pulkkinen P, Partanen J, Jalovaara P, Jamsa T . Combination of bone mineral density and upper femur geometry improves the prediction of hip fracture. Osteoporos Int 2004; 15: 274–280.

    Article  Google Scholar 

  24. Van Poznak CH . The use of bisphosphonates in patients with breast cancer. Cancer Control 2002; 9: 480–489.

    Article  Google Scholar 

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Correspondence to S Yaturu.

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Yaturu, S., DjeDjos, S., Alferos, G. et al. Bone mineral density changes on androgen deprivation therapy for prostate cancer and response to antiresorptive therapy. Prostate Cancer Prostatic Dis 9, 35–38 (2006). https://doi.org/10.1038/sj.pcan.4500846

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