Older Men With Prostate Cancer at Much Greater Risk
of Bone Fractures
Patients should be checked for osteoporosis,
particularly if treated with ADT
May 14, 2008 - As unlikely as it sounds, scientists
at the Garvan Institute for Medical Research have shown that there is a
link between prostate cancer and a higher risk of bone fracture. And,
this risk makes a significant jump if the patients have been treated
with ADT (androgen deprivation therapy).
Analysis of data from Garvans Dubbo Osteoporosis
Epidemiology Study suggests that men with prostate cancer face a 50%
higher risk of fracture, which increases to nearly doubled risk if they
are receiving treatment. The results have just been published online in
the international journal Bone.
This is a controversial area which has been under
discussion for at least three years, said Garvans Associate Professor
Tuan Nguyen, who initiated the study after hearing speculation on the
concept.
It has taken us about two years to assemble and
analyse the data. The results suggest a link between the two diseases,
although we still dont understand the mechanisms.
Professor Nguyen and his colleagues have studied
822 men from Dubbo for nearly 20 years. These men were all aged 60 or
over in 1989 when the study began.
Of the 822 men, 43 subsequently developed prostate
cancer. Twenty-two of the men received ADT (androgen deprivation
therapy) and 21 did not.
Compared to the men without prostate cancer, those
with the disease showed a 50% increase in the risk of fracture. For
those being treated with ADT, the risk increased approximately twofold.
The results have important implications in
practice for several reasons, said Nguyen. First, most of the men who
developed prostate cancer started out with a higher BMD (bone mineral
density) than average. Second, developing prostate cancer clearly
increased their risk of fracture. Third, ADT treatment doubled their
risk of fracture.
There are factors at play that we do not yet
understand. Obviously the higher BMD of the men with prostate cancer did
not protect them against fracture. Exactly what mechanisms are at work
are unclear.
Osteoporosis in men often remains untreated, even
after a fracture. It is highly unlikely, therefore, that any of the men
at higher risk will be receiving anti-fracture therapy.
The clear message that comes out of this study is
that men with prostate cancer should consider seeking evaluation for
osteoporosis, particularly if they are being treated with ADT.
More and more we are seeing ways in which diseases
are connected. You cant isolate osteoporosis from cancer from diabetes
and so on. In treating one disease, we must be careful not to increase
the risk of another. As we understand these connections, we learn how
better to treat the whole person.
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