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Article of the week: ADT increases fracture in high-risk men

Every week the Editor-in-Chief selects the Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an accompanying editorial written by a prominent member of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.

Finally, the third post under the Article of the Week heading on the homepage will consist of additional material or media. This week we feature a video of Grace LuYao discussing her paper.

If you only have time to read one article this week, it should be this one.

Fracture after androgen deprivation therapy among men with a high baseline risk of skeletal complications

Yu-Hsuan Shao*, Dirk F. Moore*, Weichung Shih*, Yong Lin*, Thomas L. Jang* and Grace L. Lu-Yao*

*The Cancer Institute of New Jersey, Department of Medicine, The Robert Wood Johnson Medical School, New Brunswick, and ‡Department of Biostatistics, UMDNJ School of Public Health, Piscataway, NJ, USA


• 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 75 994 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.


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