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. 2021 May 12;11(1):10057.
doi: 10.1038/s41598-021-89589-3.

Androgen-deprivation therapy and the risk of newly developed fractures in patients with prostate cancer: a nationwide cohort study in Korea

Do Kyung Kim  1 , Hye Sun Lee  2 , Ju-Young Park  3 , Jong Won Kim  4 , Hyun Kyu Ahn  5 , Jee Soo Ha  6 , Kang Su Cho  7
Affiliations

Androgen-deprivation therapy and the risk of newly developed fractures in patients with prostate cancer: a nationwide cohort study in Korea

Do Kyung Kim et al. Sci Rep. .

Abstract

We evaluated the risk of osteoporosis and fractures associated with androgen deprivation therapy (ADT) use and duration in men with prostate cancer. From the nationwide claims database in South Korea, a total of 218,203 men with prostate cancer were identified between 2008 and 2017. After applying the inclusion and exclusion criteria, a total of 144,670 patients were included in the analysis. To adjust for comorbidities between cohorts, 1:1 propensity score matching was used. Cox proportional hazard regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of events associated with ADT, after controlling for potential confounding factors. In the matched cohort, there were differences in the incidence of newly developed osteoporosis (8.79% in the ADT group vs. 7.08% in the non-ADT group, p < 0.0001) and fractures (8.12% in the ADT group vs. 5.04% in the non-ADT group, p < 0.0001). Age-adjusted Cox regression analysis revealed that the ADT group had a significantly higher risk of osteoporosis (HR, 1.381; 95% CI, 1.305-1.461; p < 0.0001) and fractures (HR, 1.815; 95% CI, 1.703-1.935; p < 0.0001) compared to the non-ADT group. Furthermore, the risk of osteoporosis and fractures increased as the duration of ADT increased. The ADT was associated with an increased risk of osteoporosis and fractures in prostate cancer patients. Clinicians who administer ADT for patients with prostate cancer should always be mindful of the risk of osteoporosis and fracture, avoid unnecessary ADT, and perform regular bone health check-ups.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flow diagram outlining the enrollment of the patient cohort.
Figure 2
Figure 2
Cumulative incidences of osteoporosis and fractures in the matched cohort. (A) Incidence of osteoporosis according to the use of ADT. (B) Incidence of osteoporosis according to the duration of ADT use. (C) Incidence of fractures according to the use of ADT. (D) Fractures according to the duration of ADT use. ADT androgen deprivation therapy.
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