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

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

doi:10.1186/1750-9378-6-s2-s7

Belinda F Morrison, Richard G Mayhew + Show 4 more

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https://doi.org/10.1186/1750-9378-6-s2-s7

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Abstract

BackgroundAndrogen 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.MethodsThe 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.ResultsMean ± 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).ConclusionsADT is associated with lower BMD in Jamaican men on hormonal therapy for prostate cancer.

Highlights

Jamaica is a middle income country, situated in the tropics, with a population of ~2.7 million and GNI per capita of 4,870 [1]
Of the patients with single agent exposure, leutenizing hormone releasing hormone (LHRH) analogues were the most frequently used method of Androgen deprivation therapy (ADT) (28.6%); conjugated oestrogens had the longest duration of use (60.5 mos)
In this study, we report that men with prostate cancer treated with ADT had significantly lower bone mineral density (BMD) compared with hormone naïve men with prostate cancer and controls without prostate cancer

Summary

Introduction

Jamaica is a middle income country, situated in the tropics, with a population of ~2.7 million and GNI per capita of 4,870 [1]. Prostate cancer is the leading cancer in Jamaican men, with an annual age-specific incidence rate of 65.5 per 100,000 [2]. It is the commonest cause of male cancer-related deaths in Jamaica [3]. Prolonged use of androgen deprivation therapy is associated with an increased fracture risk [10] This correlates with overall increased morbidity and reduced survival [11]. Androgen deprivation therapy (ADT) has been reported to reduce the bone mineral density (BMD) in men with prostate cancer (CaP). 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

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Results

Conclusion