Men With High Risk of Skeletal Complications More Likely to Develop Fractures After ADT

Grace Lu-Yao, PhD, MPH

Men with prostate cancer who had a high baseline risk of skeletal complications developed more fractures and had a higher mortality risk after long-term androgen-deprivation therapy (ADT) when compared to men with lower baseline risk factors.

Prior studies have analyzed the relationship between ADT and risk of bone fracture or skeletal complications. This study by The Cancer Institute of New Jersey was conducted to analyze the impact of ADT on men with high risk for skeletal complications.

“Our findings suggest that treating men having a high baseline risk of fracture with long-term androgen deprivation therapy may have serious adverse consequences,” said senior author Grace Lu-Yao, PhD, MPH, cancer epidemiologist at The Cancer Institute of New Jersey and professor of medicine at Robert Wood Johnson Medical School, in a press release.

Researchers looked at information from 75,994 men aged 66 years and older from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database from 1992 to 2007. Data regarding the use of bisphosphonates, which prevent bone loss in prostate cancer patients receiving ADT, as well as height and weight data was not available in the SEER-Medicare database.

The study found that men with high baseline risk were more likely to receive ADT compared to men with low baseline risk (52.1% vs 38.2%, P < 0.001) and that over 58% of men with high baseline risk of skeletal complications sustained at least one fracture after ADT during the 12-year follow up period.

Among patients with low baseline risk, 38% developed at least one fracture following ADT. In addition to the increased risk of fractures, those who experienced a fracture had a 1.38-fold higher mortality risk than those who did not (95% Cl, 1.34-1.43). The mortality risk for men who experienced a fracture in the first 48 months was 40% higher than those who did not.

Chronic health conditions such as diabetes, rheumatoid disease, and liver disease increase the baseline risk for skeletal complications in a patient with prostate cancer. Men with localized prostate cancer and underlying health concerns most often receive ADT as they are widely considered poor candidates for curative therapies such as surgery or radiation therapy. Newer ADTs such as abiraterone or enzalutamide can also be given to a man whose disease has spread beyond the prostate gland or has returned following surgery or radiation.

“We anticipate the results of this study will prompt further examination of a patient’s baseline-risk of fracture and skeletal complications prior to administering this course of therapy,” said Lu-Yao.