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June 5, 2004
A new study suggests that men taking a specific type of hormone therapy, called gonadotropin-releasing hormone (GnRH) agonists, for prostate cancer are at an increased risk of bone fractures. This risk increases the longer the treatment continues. GnRH agonists work by limiting production of the hormone testosterone. This type of hormone therapy is also called androgen deprivation therapy (androgens are male sex hormones).
"These results highlight the importance of osteoporotic fractures as an adverse effect of androgen deprivation therapy for prostate cancer," said lead study author Matthew R. Smith, MD, PhD, of Massachusetts General Hospital Cancer Center and Assistant Professor of Medicine at Harvard Medical School in Boston.
In this study, investigators analyzed the Medicare claims of more than 3800 men with non-metastatic prostate cancer who received GnRH agonists and compared them with the claims from more than 7700 men who did not receive these drugs. They found that men who received GnRH agonist treatment were 40% more likely to suffer a fracture than the men who did not receive this treatment. In addition, men who were on this hormone therapy for more than three years had a higher risk of fracture than those who took the drugs for one year or less.
"We were surprised by the strength and consistency of the association between GnRH agonist treatment and fractures," said Dr. Smith. "For men who require androgen-deprivation therapy, screening for osteoporosis and interventions to prevent fractures should become standard care."
What This Means For Patients
Men with prostate cancer who already receive androgen deprivation therapy should talk to their doctor about osteoporosis screening and ways to prevent fractures. For example, bisphosphonates have been shown to increase bone mineral density in men receiving GnRH treatment for prostate cancer. Men who are considering hormone therapy are encouraged to talk to their doctor about the risks and benefits of this therapy.