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. 2011 Sep 23;6 Suppl 2(Suppl 2):S7.
doi: 10.1186/1750-9378-6-S2-S7. Epub 2011 Sep 23.

Bone mineral density in Jamaican men on androgen deprivation therapy for prostate cancer

Belinda F Morrison  1 , Ingrid E Burrowes, William D Aiken, Richard G Mayhew, Horace M Fletcher, Marvin E Reid
Affiliations

Bone mineral density in Jamaican men on androgen deprivation therapy for prostate cancer

Belinda F Morrison et al. Infect Agent Cancer. .

Abstract

Background: Androgen deprivation therapy (ADT) has been reported to reduce the bone mineral density (BMD) in men with prostate cancer (CaP). However, Afro-Caribbeans are under-represented in most studies. The aim was to determine the effect of androgen deprivation therapy (ADT) on the bone mineral density (BMD) of men with prostate cancer in Jamaica.

Methods: The study consisted of 346 Jamaican men, over 40 years of age: 133 ADT treated CaP cases (group 1), 43 hormone-naïve CaP controls (group 2) and 170 hormone naïve controls without CaP (group 3). Exclusion criteria included metastatic disease, bisphosphonate therapy or metabolic disease affecting BMD. BMD was measured with a calcaneal ultrasound and expressed in S.D. units relative to young adult men (T score), according to the World Health Organization definition. Patient weight, height and BMI were assessed.

Results: Mean ± sd, age of patients in group 1 (75± 7.4 yrs) was significantly greater than groups 2 and 3 (67 ± 8.1 yrs; 65±12.0 yrs). There was no significant difference in weight and BMI between the 3 groups. . The types of ADT (% of cases, median duration in months with IQR) included LHRH (Luteinizing hormone releasing hormone) analogues (28.6%, 17.9, IQR 20.4), oestrogens (9.8%, 60.5, IQR 45.6) anti-androgens (11.3%, 3.3, IQR 15.2) and orchiectomy (15.7%, 43.4, IQR 63.9). Unadjusted t score of group 1, mean ± sd, (-1.6± 1.5) was significantly less than group 2 (-0.9±1.1) and group 3 (-0.7±1.4), p <0.001. Ninety three (69.9%), 20 (45%) and 75 (42%) of patients in groups 1, 2 and 3 respectively were classified as either osteopenic or osteoporotic (p<0.001). Adjusting for age, there was a significant difference in t scores between groups 1 and 2 as well as between groups 1 and 3 (p<0.001). Compared with oestrogen therapy and adjusting for duration of therapy, the odds of low bone mineral density (osteopenia or osteoporosis) with LHRH analogue was 4.5 (95%CI, 14.3 to 3.4); with anti-androgens was 5.9 (95%CI, 32.7 to 5); with orchiectomy was 7.3 (95%CI, 30 to 5.8) and multiple drugs was 9.2 ((95%CI, 31 to 7.1).

Conclusions: ADT is associated with lower BMD in Jamaican men on hormonal therapy for prostate cancer.

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Figures

Figure 1
Figure 1
Age-adjusted t score by Group.
Figure 2
Figure 2
Odds Ratio for low bone mineral density, adjusting for age and BMI. Low BMD; Osteoporosis and osteopenia. Group 1- prostate cancer patients receiving androgen deprivation therapy. Group 2- prostate cancer patients, hormonally naiive. Group 3- non prostate cancer patients; hormonally naiive.
Figure 3
Figure 3
Age-adjusted t score by drug class.
Figure 4
Figure 4
The risk of low BMD (osteoporosis or osteopenia) adjusting for duration of therapy. Reference drug therapy =oestrogens.
See this image and copyright information in PMC

References

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