PROSTATE CANCER AND OSTEOPOROSIS
Two new studies highlight the risk men with prostate cancer face concerning osteoporosis risk. Both show that hormone treatment for cancer can up the chances of developing the bone brittling disease.
One study in Wednesday’s New England Journal of Medicine confirms that hormonal therapy for prostate cancer increases the risk of fracture. The other, in Friday’s issue of cancer, shows that the problem of osteoporosis is often overlooked as a risk for men with prostate cancer and being treated with hormones.
Hank Rohlf, a 69 year old prostate cancer survivor, says, “With the hormonal injections I had ah hot flashes, which are common and as it turned out I had weakness and numbness and some pain in my toes and in my hands.”
Hank is experiencing the symptoms of hormone therapy for prostate cancer. This treatment denies prostate cancer cells of the male hormone testosterone, which they need to grow.
In men with proven metastasis, or spread of cancer, this androgen deprivation therapy has been shown to reduce illness, and improve suvival compared to those who got radiation alone.
Yet, now, there’s a significant proven downside.
The NEJM research shows that nearly 20 percent of men, or one in five, who received the treatment and survived at least five years after diagnosis suffered a fracture. This is compared to only about 13 percent who did not get the treatment.
The longer a man receives hormone therapy, the higher his risk. Previous studies have shown that the risk of osteoporosis-related fracture is about 5% after 22 months of treatment; after 15 years the risk jumps to 40%.
Dr. Richard Stock, Chairman of Radiology at Mt. Sinai Medical Center, says, “As with a woman who perhaps may be going through menopause and has a decrease in her estrogen levels, a decrease in a man’s testosterone levels can occur as part of a treatment can result in bone re- absorption and osteoporosis.”
And in a study published in the journal Cancer, researchers found the majority of men with prostate cancer and getting androgen-deprivation treatment didn\'t get osteoporosis prevention or treatment.
Only 8.7 percent received a bone density scan to screen for osteoporosis; only one in twenty were prescribed a bone preserving drug called a bisphosphonate, such as fosamax, which has been shown to prevent further bone loss.
Ironically, the study also found that primary-care doctors were the most aggressive at managing osteoporosis in prostate cancer patients, while cancer specialists were the least aggressive.
There are basic things a man can do.
Dr. Elliot Strauss, chief of orthopedic trauma at Mt. Sinai Medical Center adds, Definitely men should be taking calcium. They should be probably be taking calcium and vitamin D together. They should be exercising, they should be a little careful with their their smoking, their drinking.”
I’m Dr. Mike Rosen.
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