Lifestyle Factors and Duration of Androgen Deprivation Affect Bone Mineral Density of Patients with Prostate Cancer During First Year of Therapy

doi:10.1016/j.urology.2007.03.026

Urology

Volume 70, Issue 1, July 2007, Pages 122-126

https://doi.org/10.1016/j.urology.2007.03.026 Get rights and content

Objectives

Androgen deprivation therapy (ADT) is associated with loss of bone mineral density (BMD) and increased fracture risk. We sought to examine the impact of ADT and lifestyle variables on BMD in 120 patients with prostate cancer without bone metastases entering a randomized clinical trial.

Methods

A total of 120 patients with prostate cancer and without bone metastases who had been treated with ADT for less than 12 months were enrolled in a clinical trial of zoledronic acid versus placebo. BMD measurements of the femoral neck, total hip, and lumbar spine were obtained before starting the study treatment by dual energy x-ray absorptiometry. The subjects answered a questionnaire regarding possible osteoporosis risk factors, including dairy product use, caffeinated beverage use, smoking history, alcohol intake, calcium/vitamin D supplementation, thyroid medication, and exercise.

Results

The median duration of ADT was 3 months (range 0 to 12). Osteopenia or osteoporosis (T score of less than −1) was detected in two thirds of the subjects at one or more measured sites. The mean baseline BMD Z scores were femoral neck −0.091 ± 0.959, total hip 0.122 ± 1.005, and lumbar spine 0.657 ± 1.789. On multiple linear regression analysis, the duration of ADT was negatively associated with the Z score at all three sites and the body mass index, calcium/vitamin D supplementation, and alcohol use were positively associated with the Z score.

Conclusions

BMD loss is a function of the duration of ADT during the first year of therapy. The body mass index, calcium/vitamin D supplementation, and alcohol use were associated with greater BMD, even after controlling for ADT exposure.

Section snippets

Material and Methods

The US05 study was a randomized, placebo-controlled study of zoledronic acid versus placebo in patients with prostate cancer without bone metastases within the first 12 months of ADT.¹³ Men older than 18 years of age with a histologic diagnosis of prostate cancer, no evidence of metastases on bone scan, and a life expectancy of at least 12 months were eligible. The subjects must have received ADT for 12 months or less before enrollment or were to initiate ADT within 7 days after study

Results

A total of 120 men with prostate cancer and without bone metastases were enrolled. The demographic and clinical characteristics of these men are shown in Table 1. The mean age was 71.6 years, 78% were white, 73% had Stage T1-T2 disease, and 57% had a Gleason score of 5 to 7. The median duration of ADT was 3 months (range 0 to 12); 69% had received ADT for less than 6 months (including 17.5% who were ADT naive) and 31% had received ADT for 6 to 12 months. ADT was administered by luteinizing

Comment

In this cross-sectional analysis of patients with prostate cancer, we found that the duration of ADT was significantly associated with the baseline Z scores. The relationship between the Z score and exposure to ADT was in quadratic form, suggesting that BMD may rapidly decrease in the first 6 months after the initiation of ADT, followed by some recovery. Admittedly, this observation could have been due to random fluctuation, because only 31% of the subjects had received ADT for more than 6

Conclusions

The results of our study have shown that low BMD is highly prevalent in patients with prostate cancer without bone metastases during the first year of ADT. Although advanced age was likely a major factor influencing this finding, other treatment and lifestyle factors influenced BMD in our patients with prostate cancer. The duration of ADT was associated with lower BMD, especially during the initial months of treatment. Other lifestyle factors influenced bone density and should be considered in

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Adverse Health Outcomes Associated with Postdiagnosis Smoking in Prostate Cancer Patients: A Literature Review
2017, Journal of Medical Imaging and Radiation Sciences
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Studies that used data from registries may have less reliable smoking histories, as noted by the authors [18, 28, 29, 50]. Secondary analyses of studies for the impact of lifestyle factors may lack the sufficient power to detect the influence of smoking on health outcomes in this population [39]. There is a lack of literature focusing on smoking cessation in the PC patient population.
This literature review presents what is currently known about the association between postdiagnosis smoking and adverse health outcomes in prostate cancer. A literature search was conducted using Ovid Embase and Ovid MEDLINE. Information from 36 studies was summarized. There is strong evidence across the included studies of higher overall mortality and biochemical recurrence in current smokers diagnosed with prostate cancer. In addition, enhanced adverse effects following surgery, radiation, and hormone therapy have also been identified in current smokers of this population.
Cette revue de littérature présente la somme de connaissances actuelle sur l'association entre l'usage du tabac après un diagnostic de cancer de la prostate et les effets nocifs sur la santé. L’étude a été réalisée à partir des bases de données Ovid EMBASE et Ovid MEDLINE. Des renseignements provenant de 36 études ont été résumés. Les études examinées montrent une forte évidence de mortalité plus élevée et de récurrence biochimique chez les fumeurs ayant reçu un diagnostic de cancer de la prostate. De plus, des effets secondaires plus marqués après la chirurgie, la radiothérapie et l'hormonothérapie ont également été observés chez les fumeurs actuels au sein de cette population.
Bone health and its correlates in Korean prostate cancer patients receiving androgen deprivation therapy
2016, European Journal of Oncology Nursing
Citation Excerpt :
Oncology nurses play an important role in identifying such patients, ensuring timely education, interventions, and referrals (Limburg et al., 2014). While most research on bone health among this population has been conducted in western countries (Bruder et al., 2006; Chen et al., 2002; Morote et al., 2007; Morrison et al., 2011; Ryan et al., 2007; Wei et al., 1999), recent evidence suggests an ethnic variation in the effects of ADT on BMD. For example, Japanese men treated with ADT have low rates of osteoporosis (range, 8.6%–12.1%) (Wang et al., 2008; Yuasa et al., 2010), while Caucasian and African Caribbean men have high rates (range, 26.9%–42.9%) (Bruder et al., 2006; Morote et al., 2007; Morrison et al., 2011; Wei et al., 1999).
This study aimed to examine bone health status, identify factors associated with bone mineral density (BMD), and determine potential risk factors for osteoporosis in Korean prostate cancer patients receiving androgen deprivation therapy (ADT).
Using a cross-sectional descriptive design, we recruited 139 men with prostate cancer receiving ADT at two university-based hospitals in South Korea. Participants completed a self-reported questionnaire and underwent dual energy X-ray absorptiometry testing. BMD (gm/cm²), bone health status (normal BMD, osteopenia, and osteoporosis), and lifestyle variables (physical activity, smoking, and alcohol consumption) were measured.
The prevalence in our sample was 49.6% for osteopenia and 17.3% for osteoporosis. In multivariate linear regression analyses, BMD was positively associated with body mass index, number of comorbidities, and level of physical activity and negatively associated with being unemployed or retired, having a lower monthly income, and being treated with gonadotropin-releasing hormone therapy alone. In logistic regression analyses, potential risk factors for osteoporosis were low monthly income (OR = 4.33, p = 0.011), receipt of radiation therapy (OR = 4.69, p = 0.018), and lack of regular physical activity (OR = 2.63, p = 0.035).
Our results suggest that a proportion of prostate cancer survivors who are receiving ADT warrant monitoring to prevent osteoporosis, particularly men of lower economic status and those having lower levels of physical activity. Nurses can play an important role in screening these high risk groups.
Osteoporosis and Low Bone Mineral Density in Men with Testosterone Deficiency Syndrome
2015, Sexual Medicine Reviews
Testosterone deficiency syndrome (TDS) is a risk factor for low bone mineral density (BMD) and osteoporosis. Knowledge of the relationship between TDS and bone health, as well as the practical aspects of how to diagnose and treat low BMD, is therefore of practical importance to sexual medicine practitioners.
The aim of this study was to review the physiologic basis and clinical evidence of the relationship between TDS and bone health; and to provide a practical, evidence-based algorithm for the diagnosis and management of low BMD in men with TDS.
Method used was a review of relevant publications in PubMed.
Pathophysiology of low BMD in TDS, morbidity, and mortality of osteoporosis in men, association between TDS and osteoporosis, indications for dual X-ray absorptiometry (DXA) scanning in TDS, evidence for testosterone replacement therapy (TRT) in men with osteoporosis, treatment for osteoporosis in the setting of TDS.
Sex hormones play a pleomorphic role in maintenance of BMD. TDS is associated with increased risk of osteoporosis and osteopenia, both of which contribute to morbidity and mortality in men. DXA scanning is indicated in men older than 50 years with TDS, and in younger men with longstanding TDS. Men with TDS and osteoporosis should be treated with anti-osteoporotic agents and TRT should be highly considered. Men with osteopenia should be stratified by fracture risk. Those at high risk should be treated with anti-osteoporotic agents with strong consideration of TRT; while those at low risk should be strongly considered for TRT, which has a beneficial effect on BMD.
Low BMD is a prevalent and treatable cause of morbidity and mortality in men with TDS. Utilization of a practical, evidence-based approach to diagnosis and treatment of low BMD in men with TDS enables sexual medicine practitioners to make a meaningful impact on patient quality of life and longevity. Gaffney CD, Pagano MJ, Kuker AP, Stember DS, and Stahl PJ. Osteoporosis and low bone mineral density in men with testosterone deficiency syndrome.
Promoting wellness for patients on androgen deprivation therapy: Why using numerous drugs for drug side effects should not be first-line treatment
2011, Urologic Clinics of North America
Educational tool-kit on diet and exercise: Survey of prostate cancer patients about to receive androgen deprivation therapy
2010, Urology
To test a tool-kit designed to improve well-being in patients with prostate cancer. Lifestyle changes might lessen the metabolic, cardiovascular, and osseous side effects of androgen deprivation therapy (ADT) in prostate cancer patients.
Urologists supplied 10 consecutive patients initiating ADT with a tool-kit (information brochure, practical guidance on diet and exercise, recipe booklet, and lifestyle diary). The urologists completed a total 4 questionnaires, at study initiation, one at the patients' first and second visits, and one at study completion.
Overall, 91 urologists completed all questionnaires; 585 patients (median age, 75 years) were seen at the first visit, and 511 patients at the second. Patient response rate to the first questionnaire was 62% and 56% to the second. After the first visit, 82% of respondents reported being very glad or glad to receive the kit; among those having read the practical guidance (301/362), 57% had started implementation and 36% intended to do so. After the second visit, 76% were satisfied with the tool-kit and 84% were implementing guidance. Clinician satisfaction rate was 82%: benefits were improved patient dialogue (62%), follow-up (55%), and better explanation of side effects (51%). Only 14 clinicians were not pleased by the tool kit. Their main criticisms (too long, tedious, not tailored to individual needs) matched those of patients.
Written detailed guidance on diet and physical exercise for patients about to receive ADT met a genuine need and was well perceived by both clinicians and patients. Implementation rate was high. However, content should be adapted to patient age and disease stage.
The Use of Zoledronic Acid in Men Receiving Androgen Deprivation Therapy for Prostate Cancer With Severe Osteopenia or Osteoporosis
2010, Urology
To study the effect of zoledronic acid on patients with pre-existing osteoporosis on androgen deprivation therapy (ADT), who are at highest risk for fracture. Zoledronic acid is a potent bisphosphonate that can prevent osteoporosis in patients with nonmetastatic (M0), prostate cancer (CaP) who are initiating ADT. The effect of zoledronic acid on patients with pre-existing osteoporosis on ADT, who are highest risk for fracture, has not been adequately studied.
We enrolled 28 patients with M0 CaP on ADT with severe osteopenia or osteoporosis (baseline bone-mineral density (BMD) T score < −2.0) in this open-label, single-arm trial to assess the effect of zoledronic acid on BMD. All patients also received supplemental calcium and vitamin D, and were counseled about lifestyle modifications. Patients received zoledronic acid (4 mg) intravenously every 3 months for 4 treatments. BMD was measured by dual energy X-ray absorptiometry scan at enrollment, 6 and 12 months. Primary endpoint was percent change in lumbar spine BMD.
This was a high-risk patient population—primarily older Caucasians (mean age, 73 years), former smokers, and moderate users of alcohol. Mean duration of ADT was 2.4 years. Pre-existing osteopenia or osteoporosis was observed in a single site in 9 patients and multiple sites in 19 (68%). After 12 months of zoledronic acid, lumbar spine BMD increased 4.17% (P < .0001), and BMD increased significantly (P < .05) in both hips and the right femoral neck. Seven patients (25%) experienced improved BMD into the nonosteoporotic range (T score > −2.0). Zoledronic acid infusion was well tolerated and without substantial renal toxicity.
Zoledronic acid improves BMD in men with M0 CaP on ADT with severe osteopenia or osteoporosis (T scores < 2.0). This novel finding identifies a high-risk patient population that can potentially benefit from bisphosphonate therapy.

View all citing articles on Scopus

: This study was funded by Novartis Oncology, East Hanover, New Jersey.

¹: C.W. Ryan is a paid consultant to, and study investigator partially funded by, the sponsor.

²: D. Huo and J.W. Stallings are study investigators partially funded by the sponsor.

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Adult urologyLifestyle Factors and Duration of Androgen Deprivation Affect Bone Mineral Density of Patients with Prostate Cancer During First Year of Therapy

Objectives

Methods

Results

Conclusions

Section snippets

Material and Methods

Results

Comment

Conclusions

Bone loss following hypogonadism in men with prostate cancer treated with GnRH analogs

J Clin Endocrinol Metab

Risk of fracture after androgen deprivation for prostate cancer

N Engl J Med

Changes in bone mineral density, lean body mass and fat content as measured by dual energy x-ray absorptiometry in patients with prostate cancer without apparent bone metastases given androgen deprivation therapy

J Urol

Androgen deprivation therapy for prostate cancer results in significant loss of bone density

Urology

Bone mineral density in men treated with synthetic gonadotropin-releasing hormone agonists for prostatic carcinoma

J Urol

Randomized controlled trial of zoledronic acid to prevent bone loss in men receiving androgen deprivation therapy for nonmetastatic prostate cancer

J Urol

Progressive osteoporosis during androgen deprivation therapy for prostate cancer

J Urol

Osteoporosis after orchiectomy for prostate cancer

J Urol

Low bone mineral density in hormone-naive men with prostate carcinoma

Cancer

Age, body mass index, and serum prostate-specific antigen correlate with bone loss in men with prostate cancer not receiving androgen deprivation therapy

Urology

Treatment of osteoporosis in men

Calcif Tissue Int

Adult urology
Lifestyle Factors and Duration of Androgen Deprivation Affect Bone Mineral Density of Patients with Prostate Cancer During First Year of Therapy