Osteoporosis in Men with Prostate Carcinoma Receiving Androgen-Deprivation Therapy: Recommendations for Diagnosis and Therapies

Terrence H. Diamond, Celestia S. Higano, Matthew R. Smith, Theresa Guise, Frederick R. Singer

Research output: Contribution to journalArticle

220 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)892-899
Number of pages8
JournalCancer
Volume100
Issue number5
DOIs
StatePublished - Mar 1 2004
Externally publishedYes

Fingerprint

Androgens
Osteoporosis
Prostate
Carcinoma
Bone Density
Photon Absorptiometry
Therapeutics
Bone and Bones
Zygapophyseal Joint
Joint Diseases
Femur Neck
Skeleton
Hip
Spine
Randomized Controlled Trials
Retrospective Studies
Cross-Sectional Studies
Research

Keywords

  • Androgen deprivation therapy
  • Bone mineral density
  • Dual-energy X-ray absorptiometry
  • Hip fracture
  • Hypogonadal
  • Lumbar spine
  • Osteoporosis
  • Prostate carcinoma
  • Quantitative computed tomography

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Osteoporosis in Men with Prostate Carcinoma Receiving Androgen-Deprivation Therapy : Recommendations for Diagnosis and Therapies. / Diamond, Terrence H.; Higano, Celestia S.; Smith, Matthew R.; Guise, Theresa; Singer, Frederick R.

In: Cancer, Vol. 100, No. 5, 01.03.2004, p. 892-899.

Research output: Contribution to journalArticle

Diamond, Terrence H. ; Higano, Celestia S. ; Smith, Matthew R. ; Guise, Theresa ; Singer, Frederick R. / Osteoporosis in Men with Prostate Carcinoma Receiving Androgen-Deprivation Therapy : Recommendations for Diagnosis and Therapies. In: Cancer. 2004 ; Vol. 100, No. 5. pp. 892-899.
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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.",
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