Smith Matthew R, Lee Won Chan, Brandman Jane, Wang Qin, Botteman Marc, Pashos Chris L
Massachusetts General Hospital, Boston, 02114, USA.
J Clin Oncol. 2005 Nov 1;23(31):7897-903. doi: 10.1200/JCO.2004.00.6908.
Gonadotropin-releasing hormone (GnRH) agonists decrease bone mineral density, a surrogate for fracture risk, in men with prostate cancer. We conducted a claims-based cohort study to characterize the relationship between GnRH agonists and risk for clinical fractures in men with nonmetastatic prostate cancer.
Using medical claims data from a 5% national random sample of Medicare beneficiaries, we identified a study group of men with nonmetastatic prostate cancer who initiated GnRH agonist treatment from 1992 to 1994 (n = 3,887). A comparison group of men with nonmetastatic prostate cancer who did not receive GnRH agonist treatment during the study period (n = 7,774) was matched for age, race, geographic location, and comorbidity. Clinical fractures were identified using inpatient, outpatient, and physician claims during 7 years of follow-up.
In men with nonmetastatic prostate cancer, GnRH agonists significantly increased fracture risk. The rate of any clinical fracture was 7.88 per 100 person-years at risk in men receiving a GnRH agonist compared with 6.51 per 100 person-years in matched controls (relative risk, 1.21; 95% CI, 1.14 to 1.29; P < .001). Rates of vertebral fractures (relative risk, 1.45; 95% CI, 1.19 to 1.75; P < .001) and hip/femur fractures (relative risk, 1.30; 95% CI, 1.10 to 1.53; P = .002) were also significantly higher in men who received a GnRH agonist. GnRH agonist treatment independently predicted fracture risk in multivariate analyses. Longer duration of treatment conferred greater fracture risk.
GnRH agonists significantly increase risk for any clinical fracture, hip fractures, and vertebral fractures in men with prostate cancer.
促性腺激素释放激素（GnRH）激动剂会降低前列腺癌男性患者的骨矿物质密度，而骨矿物质密度是骨折风险的一个替代指标。我们开展了一项基于索赔数据的队列研究，以明确GnRH激动剂与非转移性前列腺癌男性患者临床骨折风险之间的关系。
利用来自医疗保险受益人的5%全国随机样本的医疗索赔数据，我们确定了一组在1992年至1994年开始接受GnRH激动剂治疗的非转移性前列腺癌男性患者（n = 3887）。将在研究期间未接受GnRH激动剂治疗的非转移性前列腺癌男性患者组成的对照组（n = 7774），按照年龄、种族、地理位置和合并症进行匹配。在7年的随访期间，通过住院、门诊和医生索赔记录来确定临床骨折情况。
在非转移性前列腺癌男性患者中，GnRH激动剂显著增加了骨折风险。接受GnRH激动剂治疗的男性患者中，任何临床骨折的发生率为每100人年7.88例，而匹配对照组为每100人年6.51例（相对风险，1.21；95%可信区间，1.14至1.29；P < 0.001）。接受GnRH激动剂治疗的男性患者中，椎体骨折（相对风险，1.45；95%可信区间，1.19至1.75；P < 0.001）和髋部/股骨骨折（相对风险，1.30；95%可信区间，1.10至1.53；P = 0.002）的发生率也显著更高。在多变量分析中，GnRH激动剂治疗可独立预测骨折风险。治疗时间越长，骨折风险越高。
GnRH激动剂显著增加前列腺癌男性患者发生任何临床骨折、髋部骨折和椎体骨折的风险。
