ADT and Risk of Bone Fractures: What You Should Know

Bone density loss is a common side effect of ADT, and men who are undergoing ADT are at increased risk of fractures. But how bad is that risk?

Researchers in Sweden have now used a national database to investigate the relative risk of fractures in men with prostate cancer, who were on ADT, versus men with and without prostate cancer, who had never been on ADT. A large sample of nearly 180,000 men, average age 79, was used to analyze the relative risk of fall-related injuries and fractures. The three groups of men included in the study were:  1) 159,662 men without prostate cancer, 2) 6,954 men with prostate cancer, who were on ADT, and 3) 13,128 men with prostate cancer who were not on ADT.

Statistical analyses revealed that men with prostate cancer, who were on ADT, had an increased risk of any bone fracture, hip fracture, and major osteoporotic fracture (MOF), which the authors defined as a break of the hip, vertebrae, and upper- or lower-arm, when compared to men without prostate cancer. No increased risk was identified for men with prostate cancer who were not on ADT, however.

Since ADT is strongly associated with increased risk of bone fractures, it is important for men on ADT to monitor their bone density and take steps to slow bone loss.  A DEXA scan can be used to monitor changes in bone density over time, and may help to identify potential loss of bone density. It may also be pertinent to speak with your healthcare provider about taking supplemental calcium and vitamin D.

 More information about strategies for slowing bone loss while on ADT can be found in the ADT Book, and a list of dietary sources of calcium and vitamin D is also available on our website, under the tab “Reference Tables from the ADT Book.”

For more information on the Swedish study, please the link below:

Wallander, M., Axelsson, K. F., Lundh, D., & Lorentzon, M. (2018). 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). Osteoporosis International, 1-11. doi: 10.1007/s00198-018-4722-3. [Epub ahead of print].