Admissions to hospital due to fracture in England in prostate cancer patients treated with Androgen Deprivation Therapy (ADT) - do we have to worry about the hormones?

OBJECTIVE - To investigate the relationship effect of androgen deprivation therapy (ADT) and fracture in men in the UK.

PATIENTS AND METHODS - Using the Hospital Episodes Statistics (HES) database for years 2004 to 2008 that contains all the information about NHS and NHS-funded hospital admissions in England - 8,902 patients were found to have had prostate cancer and an admission to hospital with a fracture in 2004 to 2008.

Of these 3,372 (37. 8%) were flagged as being treated with ADT, whilst there were 5,530 (62. 2%) admissions in the non ADT group (table 1). There were a total number of 228,852 admissions in the background population.

RESULTS - The risk of a fracture requiring hospitalisation increases from 1. 12 to 1. 41 per 100 person years when a man is treated with ADT with prostate cancer than without - an absolute increase of only 0. 29 per 100 person years. When compared to the background population, there is an increase from 0. 58 per 100 person years in the background population to 1. 41 - a relative rate ratio increase of 2. 4 (p<0. 01) with an absolute increase of 0. 83 per 100 person years.

CONCLUSIONS - In the UK there is a small but statistically increased risk of fracture in men who have been treated with ADT. Men with prostate cancer with or without ADT are at an increased risk of fracture compared with the background population. We therefore suggest that if bone health is to be taken seriously in men with prostate cancer that all these men should be risk assessed (FRAX or qfracture as NICE advised) rather than singling out men with ADT as all men with prostate cancer have an increased risk of fracture, with men on ADT slightly higher than without. This article is protected by copyright. All rights reserved.

BJU international. 2016 Feb 06 [Epub ahead of print]

E R Jefferies, A Bahl, L Hounsome, M F Eylert, J Verne, R A Persad, PHONIC collaborative

Department of Urology, Southmead Hospital, Bristol, UK. , Bristol Haematology & Oncology Centre, Bristol, UK. , Public Health England Knowledge & Intelligence (South West). , University Hospital of Wales, Cardiff, UK. , Public Health England Knowledge & Intelligence (South West). , Department of Urology, Southmead Hospital, Bristol, UK.