Natural history of bone complications in men with prostate carcinoma initiating androgen deprivation therapy

• Published in: Cancer Vol. 101; no. 3; pp. 541 - 549
• Main Authors: Krupski, Tracey L., Smith, Matthew R., Chan Lee, Won, Pashos, Chris L., Brandman, Jane, Wang, Qin, Botteman, Marc, Litwin, Mark S.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.08.2004; Wiley-Liss
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Age Distribution; Aged; Aged, 80 and over; androgen ablation; Androgen Antagonists - adverse effects; Androgen Antagonists - therapeutic use; Biological and medical sciences; Bone Density; Case-Control Studies; Densitometry; Diseases of the osteoarticular system; Dose-Response Relationship, Drug; Follow-Up Studies; fractures; Fractures, Spontaneous - chemically induced; Fractures, Spontaneous - diagnosis; Fractures, Spontaneous - epidemiology; Humans; Incidence; Logistic Models; Male; Medical sciences; Middle Aged; osteoporosis; Osteoporosis - chemically induced; Osteoporosis - diagnosis; Osteoporosis - epidemiology; Osteoporosis. Osteomalacia. Paget disease; prostate carcinoma; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - mortality; Prostatic Neoplasms - pathology; Reference Values; Retrospective Studies; Risk Assessment; Survival Rate; Human; Carcinoma; Androgen; Diseases of the osteoarticular system; Fracture; Malignant tumor; History; Trauma; Ablation; Osteoarticular system; Osteoporosis; Treatment; Complication; Bone; Sex steroid hormone; Urogenital system; Prostate; prostate carcinoma; fractures; androgen ablation
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.20388

BACKGROUND As evidence accumulates in favor of androgen deprivation therapy (ADT) in patients with recurrent or metastatic prostate carcinoma, concern has increased regarding bone loss associated with therapeutic hypogonadism. The current study described the natural history of bone complications in men with prostate carcinoma who have initiated ADT. METHODS Using 1992–2001 claims data from a 5% national random sample of Medicare beneficiaries, the authors identified men with prostate carcinoma who initiated ADT between 1992 and 1994. They analyzed inpatient, outpatient, and physician claims for bone complications over 7 subsequent years. They stratified the quartile of patients who survived longest into 2 cohorts: those who had received ADT for longer than and those who had received ADT for shorter than the median of 697 days. They evaluated the cumulative proportions of patients in each cohort with claims for pathologic fractures, osteoporosis/osteopenia, and nonpathologic fractures. RESULTS In the 1992–1994 sample, 4494 men with prostate carcinoma initiated ADT. Of these, 1126 survived > 2028 days (5.5 years). During the first 3 years of evaluation, the proportion of bone events was similar for men with shorter durations of ADT and men with longer durations of ADT. However, by 7 years, more men in the longer ADT cohort (45%) had sustained at least 1 pathologic or nonpathologic fracture compared with men in the shorter ADT cohort (40%). CONCLUSIONS In the current study, men with prostate carcinoma were found to be at risk for adverse bone effects from both the disease and the treatment. These longitudinal data revealed that fractures are common in this patient population and appear to be linked to the duration of ADT. Cancer 2004. © 2004 American Cancer Society. Men with prostate carcinoma are at risk for adverse bone effects from both the disease and the treatment. The longitudinal data in the current study revealed that fractures are common in this patient population and appear to be linked to the duration of androgen deprivation therapy.