Use of androgen deprivation therapy and risk of fracture and osteoporosis amongst prostate cancer survivors: A systematic review and meta-analysis


Year:

Session type:

Nada Khan1, Robert Griffiths2
1University College London, London, UK, 2University of Oxford, Oxford, UK

Background

Changes in bone physiology are found in cancer patients treated with hormone deprivation. There are several large scale studies of the risk of fracture and osteoporosis following androgen deprivation therapy (ADT) in men with prostate cancer. The purpose of this study is to conduct a systematic review of risk of fracture and osteoporosis amongst prostate cancer survivors receiving ADT.

Method

We conducted systematic searches of relevant databases using search terms related to prostate cancer, ADT, osteoporosis and fracture. Two reviewers independently screened titles and abstracts and conducted data extraction of all papers entering the review. Studies reporting odds ratios for risk of fracture were entered into a meta-analysis to produce a pooled odds ratio.

Results

Database searches identified 477 papers and 54 papers entered the review for data extraction. Papers were categorised by their main outcome; 32 studies considered a change in bone mineral density (BMD) amongst prostate cancer survivors taking ADT over time or compared to a control population, 22 studies examined the risk of fracture, and 4 studies considered the point prevalence of osteoporosis. Studies which compared risk of fracture against a control population reported an increased risk following use of ADT, with a pooled odds ratio for risk of any fracture of 1.37 (95% CI 1.34-1.41). 14 papers reported the duration of ADT; longer duration of ADT use was associated with a higher risk of fracture. Studies considering changes in BMD over time reported mixed results, however the trend was for lower BMD following use of ADT.

Conclusion

Use of ADT amongst prostate cancer survivors is associated with an increased risk of fracture, with several studies demonstrating lower BMD and higher rates of osteoporosis. These findings have implications for the long-term care of the growing number of survivors of prostate cancer. This work will be used to develop a risk stratification algorithm to predict risk of fracture amongst prostate cancer survivors.