Osteoporosis in men with prostate carcinoma receiving androgen-deprivation therapy

Recommendations for diagnosis and therapies

Authors

  • Terrence H. Diamond M.D.,

    Corresponding author
    1. Department of Medicine, University of New South Wales, St. George Hospital Campus, Sydney, Australia
    • University of New South Wales, St. George Hospital Campus, Sydney, New South Wales 2217, Australia
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    • Fax: (011) 612 93503966

  • Celestia S. Higano M.D.,

    1. Department of Medicine, University of Washington, Seattle, Washington
    2. Seattle Cancer Care Alliance, Seattle, Washington
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  • Matthew R. Smith M.D., Ph.D.,

    1. Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Theresa A. Guise M.D.,

    1. Division of Endocrinology, Department of Internal Medicine, University of Virginia, Charlottesville, Virginia
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  • Frederick R. Singer M.D.

    1. Department of Clinical Medicine, University of California at Los Angeles School of Medicine, Los Angeles, California
    2. John Wayne Cancer Institute, Santa Monica, California
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  • Novartis Pharmaceuticals did not have any input regarding the preparation of this article. The recommendations outlined in the current article were based on the consensus of the working party.

  • Clinical oncologists with a special interest in prostate carcinoma and representatives of the various oncology groups from North America attended the symposium on which the current article is based. The input and discussions of the symposium attendees contributed significantly to the preparation of the current article. Aside from the authors, the study participants included Robert DiPaola, Maha Hussain, Richard Kaplan, Julie Kish, Fred Saad, Howard Sandler, Daniel Shevrin, and Eric Small.

Abstract

BACKGROUND

Androgen-deprivation therapy (ADT) is prescribed with increasing frequency for men with prostate carcinoma. There is growing concern about the effects of such therapy on the skeleton. In the current review, the authors addressed the current research, diagnostic methods, and treatment recommendations for bone loss and osteoporosis in men with prostate carcinoma who received ADT.

METHODS

Data were obtained from electronic literature searches (for the years 1986 through 2002) and from abstracts and meeting proceedings. All randomized and nonrandomized clinical trials, retrospective studies, and cross-sectional studies of osteoporosis in men with prostate carcinoma who received ADT with or without other therapies were reviewed.

RESULTS

The findings confirmed that ADT resulted in significant bone loss in men with prostate carcinoma. Bone mineral density (BMD) of the hip, as measured by dual-energy X-ray absorptiometry (DXA), is considered the preferred site of assessment in older men. Spinal BMD is equally important, although careful interpretation of spinal DXA values is required, because of coexisting facet joint disease and extravertebral calcification. Osteoporosis is diagnosed when BMD is > 2.5 standard deviations below a reference mean. Men with prostate carcinoma who were treated with ADT had average BMD measurements below those of eugonadal men. Rates of bone loss ranged from 2% to 8% in the lumbar spine and from 1.8% to 6.5% in the femoral neck during the initial 12 months of continuous ADT. Retrospective data indicated an increased risk of fracture in men with prostate carcinoma who were treated with ADT.

CONCLUSIONS

For men with prostate carcinoma who are at high risk for osteoporosis and fractures, clinical management should be dictated by the results of radiographic and DXA skeletal assessment. Cancer 2004;100:892–9. © 2004 American Cancer Society.

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