Dr. Paul Blood at the BC Cancer Agency's Vancouver Island Centre has undertaken a systematic review of the literature, and the meta-analysis is summarised as follows:
Bone Mineral Density (BMD) Review:
- Cross-sectional studies:
A total of 154 men with prostate cancer on androgen ablation (AA) have had the BMD analyzed in five cross-sectional studies (14, 21-24). The combination of these studies shows that the hip loses 3% (CI 2-4%) BMD per annum from 2-10 years of AA (Blood, personal communication). The lumbar spine loses 1% (CI 0-2%) per annum from 2-10 years. - Longitudinal studies:
A total of 161 men with prostate cancer on AA have had BMD analyzed in six longitudinal studies (25-30). The combination of theses studies shows that the femoral neck loses 4% (CI 1-7%) per annum for the first two years of AA. The lumbar spine also loses 4% (CI –1 to 8%) per annum for the first two years.
Fracture Risk Review:
Although BMD loss is of concern, fractures are the main cause of morbidity, mortality, wrong diagnosis, unnecessary investigation and treatment. A total of 836 men with prostate cancer on AA were screened for osteoporotic fractures in four studies (14-16, 31). The combination of theses studies yields an odds ratio for all osteoporotic fractures of 7 (CI 3-17). Those at the hip have more serious consequences and the odds ratio for hip fractures is 5 (CI 3-10).
