Cancer Institute of New Jersey, NJ, USA.
BJU Int. 2013 May;111(5):745-52. doi: 10.1111/j.1464-410X.2012.11758.x. Epub 2013 Jan 17.
WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Receipt of androgen deprivation therapy (ADT) has been associated with an increased risk of skeletal-associated complications, such as a decrease in bone mineral density and an increase in fracture risk. Many men with pre-existing health conditions receive ADT as their primary treatment because they are considered to be inappropriate candidates for attempted curative treatments. However, several chronic health conditions, such as diabetes, rheumatoid disease and chronic liver disease, are strong predictors for osteoporosis and fractures. We undertook the present study aiming to quantify the impact of treating men with ADT who carry known risk factors for skeletal complications. Among these high-risk men, more than 58% develop at least one fracture after ADT within the 12 years of follow-up. Men who sustained a fracture within 48 months experienced an almost 40% higher risk of mortality than those who did not. Our findings suggest that treating men with a high fracture risk at baseline with long-term ADT may have serious adverse consequences.
To quantify the impact of androgen deprivation therapy (ADT) in men with a high baseline risk of skeletal complications and evaluate the risk of mortality after a fracture.
We studied 75994 men, aged ≥ 66 years, with localized prostate cancer from the Surveillance, Epidemiology and End Results-Medicare linked data. Cox proportional hazard models were employed to evaluate the risk.
Men with a high baseline risk of skeletal complications have a higher probability of receiving ADT than those with a low risk (52.1% vs 38.2%, P < 0.001). During the 12-year follow-up, more than 58% of men with a high risk and 38% of men with a low risk developed at least one fracture after ADT. The dose effect of ADT is stronger among men who received ADT only compared to those who received ADT with other treatments. In the high-risk group, the fracture rate increased by 19.9 per 1000 person-years (from 52.9 to 73.0 person-years) for men who did not receive ADT compared to those who received 18 or more doses of gonadotropin-releasing hormone agonist among men who received ADT only, and by 14.2 per 1000 person-years (from 45.2 to 59.4 person-years) among men who received ADT and other treatments. Men experiencing a fracture had a 1.38-fold higher overall mortality risk than those who did not (95% CI, 1.34-1.43).
Men with a high baseline risk of skeletal complications developed more fractures after ADT. The mortality risk is 40% higher after experiencing a fracture. Consideration of patient risk before prescribing ADT for long-term use may reduce both fracture risk and fracture-associated mortality.
量化基线存在高骨骼并发症风险男性接受雄激素剥夺治疗（ADT）的影响，并评估骨折后死亡的风险。
我们研究了来自监测、流行病学和最终结果-医疗保险关联数据的 75994 名年龄≥66 岁的局限性前列腺癌男性患者。采用 Cox 比例风险模型评估风险。
基线存在高骨骼并发症风险的男性比低风险者更有可能接受 ADT（52.1%比 38.2%，P<0.001）。在 12 年的随访期间，高风险组中有 58%以上的男性和低风险组中有 38%的男性在接受 ADT 后至少发生了一次骨折。与接受 ADT 联合其他治疗的男性相比，仅接受 ADT 的男性中 ADT 剂量的影响更强。在高风险组中，与未接受 ADT 的男性相比，仅接受 ADT 的男性中未接受 ADT 的男性骨折发生率增加了 19.9/1000 人年（从 52.9 人年增至 73.0 人年），而接受 ADT 联合其他治疗的男性骨折发生率增加了 14.2/1000 人年（从 45.2 人年增至 59.4 人年）。发生骨折的男性总死亡率风险比未发生骨折的男性高 1.38 倍（95%CI，1.34-1.43）。
基线存在高骨骼并发症风险的男性在接受 ADT 后发生更多骨折。发生骨折后死亡风险增加 40%。在长期使用 ADT 之前考虑患者的风险，可能会降低骨折风险和骨折相关的死亡率。
