Fracture risk in Danish men with prostate cancer: a nationwide register study
Article first published online: 15 AUG 2007
Volume 100, Issue 4, pages 749–754, October 2007
How to Cite
Abrahamsen, B., Nielsen, M. F., Eskildsen, P., Andersen, J. T., Walter, S. and Brixen, K. (2007), Fracture risk in Danish men with prostate cancer: a nationwide register study. BJU International, 100: 749–754. doi: 10.1111/j.1464-410X.2007.07163.x
- Issue published online: 15 AUG 2007
- Article first published online: 15 AUG 2007
- Accepted for publication 27 April 2007
- hip fracture;
- male osteoporosis;
- prostate cancer;
- androgen deprivation therapy
This section opens with a nationwide Danish study on the risk of fractures in prostate cancer, as well as assessing the impact of exposure to androgen deprivation. The authors found that there was a marked increase in the risk of fractures, especially of the hip.
Authors from the USA address the outcome of cytoreductive nephrectomy for metastatic RCC, finding that it can be predicted by the fraction of tumour volume removed. They give an informative review of the topic and describe their experience in this type of surgery.
Treatment options for hormonerefractory prostate cancer are rather limited and authors from the USA present the results of a phase II trial into the use of gefitinib as a single therapy in patients with non-metastatic refractory disease. They found an absence of PSA response but confirmed the well-established favourable tolerability profile of this agent.
To assess the risk of fracture attributable to prostate cancer, and the impact of exposure to prescribed gonadotrophin-releasing hormone agonists and antiandrogens on this risk in a nationwide, population-based case-control study.
PATIENTS AND METHODS
Data from the Danish National Hospital Discharge Register, the National Bureau of Statistics, and the National Prescriptions Database were merged. The analysis covered 15 716 men aged >50 years presenting with a fracture at any hospital in Denmark in 2000, and 47 149 age-matched control men. A previous diagnosis of prostate cancer had been recorded in 1.3% of controls and 2.5% of those with a fracture.
Prostate cancer was associated with an increased odds ratio (95% confidence interval) for all fractures of 1.8 (1.6–2.1), for hip fractures of 3.7 (3.1–4.4), but no increased risk of vertebral fractures. The increased fracture risk became apparent early after diagnosis and remained pronounced even in long-term survivors. Androgen deprivation therapy (ADT) with an odds ratio of 1.7 (1.2–2.5; P < 0.01) and orchidectomy, at 1.7 (1.2–2.4; P < 0.01) added to the overall fracture risk. In all, 3.1% of hip fractures in Danish men aged >50 years are attributable to prostate cancer.
Prostate cancer, orchidectomy and the use of ADT are associated with a markedly greater risk of fractures, especially of the hip. The risk of hip fracture is not confined to the very old, neither is the risk made negligible by the excess mortality in patients with advanced prostate cancer.