Lau Yiu-Keung, Lee Ellen, Prior Heather J, Lix Lisa M, Metge Colleen J, Leslie William D
Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
Can J Urol. 2009 Dec;16(6):4908-14.
Prostate cancer is the most common noncutaneous malignancy diagnosed in men. The use of androgen deprivation therapy (ADT) is the mainstay of treatment for metastatic disease. The use of ADT has been reported to increase the risk of osteoporosis in men with prostate cancer, with higher risk of fracture than age matched controls. We sought to confirm the higher fracture risk of men with prostate cancer on ADT in the Canadian population.
We used the Population Health Research Data Repository housed at Manitoba Centre for Health Policy to identify all cases of fractures of the hip, vertebra, or wrist in men aged 50 years and older occurring between 1996 and 2004. Each case was matched with up to three controls by age, sex, ethnicity and medical comorbidity. We calculated the odds ratios (OR) for fracture with prostate cancer, and with or without ADT, after adjusting for possible confounding variables.
There were 4696 cases of fracture matched with 14080 controls. After controlling for confounding variables, there was no significant association between prostate cancer and fracture risk (adjusted OR = 0.97, 95% confidence intervals [CI]: 0.83-1.15). We detected a significant association between ADT and fracture risk in men. The adjusted ORs for current and past ADT usage were 1.71 (95% CI: 1.13 - 2.58) and 2.42 (95% CI: 1.42-4.12) respectively.
Our findings suggest that prostate cancer itself does not increase the risk of fracture and corroborate published results demonstrating an association between ADT and fractures.
前列腺癌是男性中最常见的非皮肤恶性肿瘤。雄激素剥夺疗法（ADT）的使用是转移性疾病治疗的主要手段。据报道，ADT的使用会增加前列腺癌男性患骨质疏松症的风险，其骨折风险高于年龄匹配的对照组。我们试图在加拿大人群中证实接受ADT治疗的前列腺癌男性骨折风险更高。
我们使用了曼尼托巴省卫生政策中心的人口健康研究数据存储库，以识别1996年至2004年间50岁及以上男性发生的髋部、脊椎或腕部骨折的所有病例。每个病例按年龄、性别、种族和医疗合并症与最多三个对照组进行匹配。在调整可能的混杂变量后，我们计算了前列腺癌患者骨折的比值比（OR），以及接受或未接受ADT治疗患者骨折的比值比。
有4696例骨折病例与14080例对照匹配。在控制混杂变量后，前列腺癌与骨折风险之间无显著关联（调整后的OR = 0.97，95%置信区间[CI]：0.83 - 1.15）。我们检测到ADT与男性骨折风险之间存在显著关联。当前和过去使用ADT的调整后OR分别为1.71（95% CI：1.13 - 2.58）和2.
