Skeletal fracture associated with androgen suppression induced osteoporosis: The clinical incidence and risk factors for patients with prostate cancer

Purpose: Limited information exists regarding the long-term risk of skeleta l fracture in men on androgen suppression for prostate cancer. In addition, the clinical risk factors predisposing them to skeletal fracture are incom pletely defined. We define the long-term risk and clinical risk factors for skeletal fracture in patients with prostate cancer on chronic androgen sup pression. Materials and Methods: A total of 181 consecutive patients with prostate ca ncer on androgen suppression therapy were evaluated. The primary end point was skeletal fracture. Comprehensive demographic information was gathered, and univariate and multivariate analyses were performed to identify associa tions with skeletal fracture. Results: The proportion of patients who had survived fracture-free at 5 and 10 years on androgen suppression therapy was 96% and 80%, respectively. Th e black race (p = 0.009) and increased body mass index (p = 0.024) were ide ntified as protective against androgen suppression associated skeletal frac tures. A significant correlation was identified between the duration of and rogen suppression and risk of skeletal fracture (p = 0.003). Conclusions: Patients with prostate cancer treated with androgen suppressio n are at risk for skeletal fracture, and risk increases with the duration o f therapy. Slender white men are at greatest risk. Conversely, black men an d those with body mass indexes greater than normal (greater than 25 kg./m.( 2)) are at minimal risk despite a prolonged duration (10 years) of androgen suppression.