Androgen Deprivation In Veterans With Prostate Cancer: Implications For Skeletal Health

UroToday.com- In addition to prostate cancer (CaP) patients with metastatic disease, androgen-deprivation therapy (ADT) is increasingly used for patients with non-metastatic recurrent disease. This means that the long-term consequences of ADT to include bone loss are more likely. Patients on ADT may also have other risk factors for bone loss to include alcohol abuse, smoking, prior fracture or a propensity for bone trauma secondary to falling. In the online version of the Annals of Pharmacotherapy, Dr. Wilcox and associates evaluated skeletal health in a population of Veterans on ADT at the Minnesota VA. They proposed three hypotheses; that fracture risk factors in addition to ADT would exist in most of these patients, bone mass measurements would be performed in a minority, and a minority of patients would receive bisphosphonate therapy.

Veterans over age 50 years who received ADT between 1993 and 2001 were identified through VA pharmacy service records. Medical records of these men were then reviewed. Of the 351 patients identified, 174 met study criteria. Median duration of ADT was 21 months and 57% received LHRH monotherapy without an anti-androgen. Additional skeletal risk factors were identified in 81% and smoking, alcohol use and prior fracture were most common.

Of the 174 men, only 22 (13%) had bone mineral density measurement (BMD) performed. Seven of these 22 men had BMD prior to initiation of treatment and 5 were found to be osteoporotic. The other 15 had BMD testing after initiation of ADT and 8 were osteoporotic after beginning ADT (median time 29 months). Fewer than half of the men received either calcium or vitamin D supplements for skeletal health and only 11% received antiresorptive therapy. Seventeen of the 22 men who had BMD measured received antiresorptive therapy. Fractures occurred in 24 men, most commonly vertebrae and hip. In those with fractures, 11 had one other risk factor for osteoporosis in addition to ADT. Only 6 of the patients with fractures were on antiresorptive therapy. The fracture rate was not different between men on combined androgen blockade or monotherapy.

This study found that in their population of Veterans on ADT, skeletal risk factors existed in 80%, BMD was infrequently measured and only 11% received antiresorptive therapy. Unfortunately, the analysis did not seem to determine whether patients were started on ADT for metastatic disease or non-metastatic disease. In the 24 men who experienced a fracture, the duration of their ADT prior to the fracture and whether the fracture was associated with a metastatic site on imaging was not reported.

Andrew Wilcox, Molly L Carnes, Timothy D Moon, Renee Tobias, Heather Baade, Emily Stamos, and Mary E Elliott
Annals of Pharmacotherapy 2006: 40: 2107 - 2114

Reviewed by UroToday.com Contributing Editor Christopher P. Evans, M.D.

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