Prostate Cancer Therapy Ups Osteoporosis Risk

Prostate cancer patients who receive hormone treatment are at silent risk for the brittle bone disease osteoporosis (search), and yet few patients are ever screened for the condition.

The Jan. 15, 2005 issue of the journal Cancer shows that even men with existing osteoporosis risk factors, like smoking or extended hormone use, “are still unlikely to receive prevention or treatment.”

Hormone therapy — called androgen deprivation therapy — is the standard treatment for men whose prostate cancer remains after a prostatectomy and for those whose disease spreads or reoccurs. Hormone therapy denies prostate cancer cells of the male hormone testosterone, which they need to grow.

It is well known that hormone therapy, however, can lead to accelerated osteoporosis and bone fractures. The longer a man receives hormone therapy, the higher his risk. Previous studies have shown that the risk of osteoporosis-related fracture is about 5 percent after 22 months of treatment; after 15 years the risk jumps to 40 percent.

Tawee Tanvetyanon, MD, from Loyola University Chicago Stritch School of Medicine, reviewed medical records from 184 men with prostate cancer undergoing hormone therapy. He found that only one in seven men received any kind of osteoporosis prevention or treatment.

Among the other findings:

—Only 8.7 percent of the men had a bone density scan within three years to look for thinning bones.

—Only one in 20 were prescribed an osteoporosis medication.

Primary care doctors managed osteoporosis most aggressively; cancer specialists were the least aggressive when it came to managing the disease.

Osteoporosis prevention and treatment is critical to warding off further bone loss. Thinning bones can trigger fractures and lead to falls, the leading cause of injury death in people aged 65 and older. Aging itself can increase risk for osteoporosis. Certain medications can cause bone loss, too. Besides hormone therapy, other risk factors include alcoholism and smoking.

“It is worrisome that other concurrent risk factors for osteoporosis did not lead to increased osteoporosis prevention. Theoretically these patients have higher risks of osteoporotic fracture and should be deemed a priority,” Tanvetyanon writes.

Tanvetyanon speculates that the lack of established osteoporosis guidelines for men may contribute to the underuse of prevention and treatment techniques.

“A great opportunity to improve osteoporosis prevention among men receiving [hormone therapy] exists,” he writes.

By Kelli Miller Stacy, reviewed by Michael W. Smith, MD

SOURCES: Tanvetyanon, T. Cancer, Jan. 15, 2005. News release, John Wiley & Sons Inc.