An under-recognised riskBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c143 (Published 13 January 2010) Cite this as: BMJ 2010;340:c143
- Jennifer M Sherriff, specialist registrar clinical oncology1,
- Janet E Brown, Cancer Research UK clinician scientist 2,
- Nicholas D James, professor of clinical oncology1
- 1University Hospital Birmingham NHS Trust, Birmingham B15 2TH
- 2Cancer Research UK Clinical Centre, Leeds St James’s Hospital, Leeds LS9 7TF
Osteoporosis is another important but under-recognised risk of androgen deprivation therapy.1 Few guidelines exist to help detect and manage bone loss in these men.
As survival from prostate cancer increases, osteoporosis and its complications will probably become more common. A retrospective study of over 50 000 men with prostate cancer found a significant association between number of doses of gonadotrophin releasing hormone agonist and fracture risk.2 Importantly, fractures in these patients are an independent adverse predictor of survival.3
Patients and general practitioners should be given clear information and lifestyle advice to reduce the risk of osteoporosis, emphasising the need for exercise, reducing smoking, limiting alcohol consumption, and a diet that includes calcium and vitamin D. Exercise and diet are particularly important because the effects of androgen deprivation include muscle loss and increased body fat.
In the absence of guidelines, teams managing prostate cancer need to formulate and implement coherent strategies to minimise morbidity from this treatment. Dual energy x ray absorptiometry (DXA) scans are cheap, easy to perform, and underused in these patients in the UK. We recommend that a DXA scan be considered for all men starting long term androgen deprivation therapy.
Cite this as: BMJ 2010;340:c143
Competing interests: JEB has received speakers’ bureau honorariums from Novartis and Amgen and has served on advisory boards or as a consultant for Novartis, Amgen, Roche, and Bristol-Myers Squibb. JMS has no competing interests. NDJ has received research funding from and has carried out consultancy work for Novartis, Sanofi Avantis, and Pfizer.