Men who receive androgen deprivation therapy (ADT) for prostate cancer are at elevated risk of osteoporotic fractures, new study findings confirm. The increased risk is especially pronounced in younger men.

The study found no clinically relevant relationships between ADT and non-skeletal fall injury, “which further strengthens the assumption that the relationship between ADT and fracture is primarily bone-related,” Märit Wallander, MD, of Karolinska Institute in Stockholm, Sweden, and colleagues reported in Osteoporosis International.

The investigators concluded that “osteoporosis medications should be considered as routine procedures in all patients with prostate cancer already at the initiation of androgen deprivation therapy.”

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The study included 179,744 men with a mean age of 79.1 years. The cohort included 159,662 without PCa, 6954 with PCa and current ADT, and 13,128 men with PCa who did not receive ADT. The investigators identified 10,916 incident fracture—including 4860 hip fractures—during a follow-up of about 270,300 patient-years.

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Compared with men who did not have PCa, those who had PCa with ADT had a significant 40% increased risk of any fracture, 38% increased risk of hip fracture, and 44% increased risk of major osteoporotic fracture (MOF), after adjusting for multiple potential confounding variables. Compared with men with PCa but not ADT, ADT recipients had a significant 34%, 38%, and 34% increased risk of any fracture, hip fracture, and MOF, respectively. The investigators found no increased risk of any fracture, hip fracture, or MOF among men with PCa who did not receive ADT. Men with PCa receiving ADT did not have an increased risk of non-skeletal fall injury.


Wallander M, Axelsson KF, Lundh D, Lorentzon M. Patients with prostate cancer and androgen deprivation therapy have increased risk of fractures—a study from the fractures and fall injuries in the elderly cohort (FRAILCO). Osteoporos Int. 2018; published online ahead of print.