©TheCanadian Journal ofUrology™: International Supplement, April 2014
TABLE1.
Observedchanges inbonemineraldensityat12months inpatients treatedwithandrogendeprivation
therapy
Study
Patient number
Treatment
BMD changes at 12months
Eriksson et al
7
27
Orchiectomyor oestrogens
Hip: -9.6%
Radius: -4.5%
Maillefert et al
8
12
LHRH agonist
Hip: -3.9%
Lumbar spine: -4.6%
Daniell et al
10
235
OrchiectomyorLHRH agonist
Hip: -2.4%
Berrutti et al
50
35
LHRH agonist
Hip: -0.6%
Lumbar spine: -2.3%
*Higano et al
51
19
LHRH agonist
Hip: -2.7%
Lumbar spine: -4.7%
Mittan et al
13
15
LHRH agonist
Hip: -3.3%
Radius: -5.3%
*9months of androgendeprivation therapy
BMD=bonemineral density; LHRH= luteinizinghormone releasinghormone
TABLE2.
Riskof fractureassociatedwith chronicadministrationof androgendeprivation therapy (ADT)
Study
Patient
ADT
Fracture risk (%)
number duration All sites
Hip Hospitalization
ADT No
ADT No
ADT No
ADT
ADT
ADT
Shahinian et al
15
50613
1yr-5yr
19.6
12.6
4.06
2.06
5.19 2.37
Smith et al
16
11661
> 12yr
7.88*
¶
6.51*
¶
1.26*
0.98*
Alibhai et al
14
19079
6.7yr
17.2
¶¶
12.7
¶¶
2.6
2
8
5.7
*rateper 100person-years;
¶
relative risk 1.21; p< 0.001
¶¶
hazard ratio 1.65, 95%CI 1.53-1.78
aimof this review is tounderstand thebasic factsand
figures of CTIBLandbonemetastasis and toprovide
some guidance on when and how to administer
preventive or curative measures. This reviewwill
not include information on recent developments in
diagnostic techniques ordataon radionuclides.
ADTinducedCTIBLinprostatecancerpatients
The association between surgical castration and
accelerated bone loss was first describedmore than
15 years ago and confirmed since then by several
prospective studies.
7-12
After 12months ofADT, men
wouldusually losebetween2%and10%of theirbone
mineraldensity(BMD),measuredbydual-energyx-ray
absorptiometry (DXA) at their hip or radius, Table 1.
CTIBLbeginsveryearly in thecourseof treatmentwith
ADT,assuggestedbytheconcentrationofurinarybone
resorptionmarkerN-telopeptide thatalready increases
after6monthsofADT.
13
Largeepidemiologicalsurveys
havedemonstrated thatADT inducedCTIBL increases
the riskof fragility fracture,modestlybut significantly,
Table2.
14-16
This riskmayalthoughbecome significant
when added to other traditional risk factors such as a
loworhighbodymassindex,ahistoryofapriorfracture
atmore than 50 years of age, aparental historyof hip
fracture,beingacurrentsmoker,receivingcorticosteroid
treatment for>3months,anexcessivealcoholuse,and
a history of rheumatoid arthritis.
17
These additional
risk factorsare important todecide ifapatient requires
treatment. In addition, the impact ofADT should be
modulated according to the ageof thepatient and the
duration of treatment. In one of the aforementioned
surveys, the relative risk of any fracturewas 1.07 for
patients receiving ≤ 4 monthly doses of luteinizing
hormonereleasinghormone (LHRH)agonistsand1.45
for≥9doses, therelativerisk increasingby1.21foreach
age5year categories.
15
85
ButoescuANDTombal
