Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea.
Sci Rep. 2021 May 12;11(1):10057. doi: 10.1038/s41598-021-89589-3.
We evaluated the risk of osteoporosis and fractures associated with androgen deprivation therapy (ADT) use and duration in men with prostate cancer. From the nationwide claims database in South Korea, a total of 218,203 men with prostate cancer were identified between 2008 and 2017. After applying the inclusion and exclusion criteria, a total of 144,670 patients were included in the analysis. To adjust for comorbidities between cohorts, 1:1 propensity score matching was used. Cox proportional hazard regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of events associated with ADT, after controlling for potential confounding factors. In the matched cohort, there were differences in the incidence of newly developed osteoporosis (8.79% in the ADT group vs. 7.08% in the non-ADT group, p < 0.0001) and fractures (8.12% in the ADT group vs. 5.04% in the non-ADT group, p < 0.0001). Age-adjusted Cox regression analysis revealed that the ADT group had a significantly higher risk of osteoporosis (HR, 1.381; 95% CI, 1.305-1.461; p < 0.0001) and fractures (HR, 1.815; 95% CI, 1.703-1.935; p < 0.0001) compared to the non-ADT group. Furthermore, the risk of osteoporosis and fractures increased as the duration of ADT increased. The ADT was associated with an increased risk of osteoporosis and fractures in prostate cancer patients. Clinicians who administer ADT for patients with prostate cancer should always be mindful of the risk of osteoporosis and fracture, avoid unnecessary ADT, and perform regular bone health check-ups.
我们评估了雄激素剥夺疗法（ADT）在前列腺癌患者中的使用及其持续时间与骨质疏松症和骨折风险的相关性。从韩国全国范围内的索赔数据库中，我们在 2008 年至 2017 年期间确定了 218203 名患有前列腺癌的男性。在应用纳入和排除标准后，共有 144670 名患者纳入分析。为了调整队列之间的合并症，我们使用了 1:1 倾向评分匹配。使用 Cox 比例风险回归模型来估计与 ADT 相关的事件的调整后的危险比（HR）和 95%置信区间（CI），同时控制了潜在的混杂因素。在匹配队列中，新发生的骨质疏松症（ADT 组为 8.79%，非 ADT 组为 7.08%，p<0.0001）和骨折（ADT 组为 8.12%，非 ADT 组为 5.04%，p<0.0001）的发生率存在差异。年龄调整的 Cox 回归分析显示，ADT 组发生骨质疏松症的风险显著更高（HR，1.381；95%CI，1.305-1.461；p<0.0001）和骨折（HR，1.815；95%CI，1.703-1.935；p<0.0001），与非 ADT 组相比。此外，随着 ADT 持续时间的增加，骨质疏松症和骨折的风险也随之增加。ADT 与前列腺癌患者骨质疏松症和骨折风险的增加相关。为前列腺癌患者进行 ADT 治疗的临床医生应始终注意骨质疏松症和骨折的风险，避免不必要的 ADT，并定期进行骨骼健康检查。
