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.
PATIENTS AND METHODS
• 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.