Bone loss associated with the use of LHRH agonists in prostate cancer

Hypogonadism is a recognised cause of osteoporosis in men. When patients wi th advanced prostate cancer are treated with luteinising hormone releasing hormone (LHRH) agonist analogues their circulating testosterone levels decl ine and these patients may develop fractures. We have undertaken a cross-sectional study on a cohort of patients treated with goserelin (n = 41) and compared their bone density and bone turnover w ith patients with prostate cancer not on goserelin and elderly patients liv ing in the community. There was no difference in bone density between the patients on treatment a nd those living in the community and there was a similar incidence of osteo porosis (50 and 42%, respectively). The bone marker measurements were highe r in the treated patients: urine N-telopeptide (NTX) 80.1 (9) (mean (s.e.)) BCE/mmol, compared to 30.1 (2.9), P < 0.001 in elderly patients; and bone alkaline phosphatase 41.9 (6.1) u/l in treated patients and 20.7 (1.5) in u ntreated prostate cancer patients, P < 0.002. Patients on treatment with ra dionuclide scan evidence of metastases did not have higher bone marker valu es than those with negative scans. As increased bone turnover and low bone density are associated with enhance d risk of osteoporotic fractures, we suggest that patients on LHRH agonist analogues should receive advice and possibly anti-bone resorptive treatment with bisphosphonates, to prevent further bone loss and fractures.