Editing Hormonal Therapy (section)

=== Osteoporosis ===

* Prostate cancer occurs mostly in older men, who are at increased risk for osteoporosis, even in the absence of ADT
* '''ADT associated with (3):'''
** '''Decreased bone mineral density (BMD)'''
*** BMD loss occurs at a maximum rate during the first year of therapy, however, continues to decline with prolonged use of ADT
** '''Osteoporosis'''
*** Osteoporosis is defined as BMD of 2.5 or more standard deviations below the peak bone mass for young adults (i.e., T-score ≤-2.5).
*** Osteopenia (low bone mass) is defined as BMD more than 1.0 but less than 2.5 standard deviations below the peak bone mass for young adults (i.e., T-score <-1 and >-2.5).
*** '''4 years of ADT will place the average man in the osteopenia''' (precursor of osteoporosis) '''range'''.
** '''Increased risk for clinical fractures'''
*** '''Shahinian et al. NEJM 2005'''
**** Population: 50,613 males from SEER with a diagnosis of prostate cancer
**** Comparison: patients treated with or without ADT
**** Primary outcomes: occurrence of any fracture and pccurrence of a fracture resulting in hospitalization
**** Results:
***** Risk of facture within 5 years of prostate cancer diagnosis: 19% with ADT vs. 13% without ADT
***** Risk of facture requiring hospitalization within 5 years of prostate cancer diagnosis: 5.2% with ADT vs. 2.4% without ADT
***** Risk of fracture increased with increasing number of ADT doses
**** Shahinian, Vahakn B., et al. "Risk of fracture after androgen deprivation for prostate cancer." New England Journal of Medicine 352.2 (2005): 154-164.