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Changes in bone mineral density in men starting androgen deprivation therapy and the protective role of vitamin D

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Abstract

Summary

Androgen deprivation therapy in 80 men was associated with declines in bone mineral density (BMD), which were greatest in the first year, and in the lumbar spine compared to controls. Vitamin D use was associated with improved BMD in the lumbar spine and in the first year.

Introduction

Decreased BMD is a common side effect of androgen deprivation therapy (ADT), leading to increased risk of fractures. Although loss of BMD appears to be greatest within the first year of starting ADT, there are few long-term studies of change in BMD, and risk factors for bone loss are not well-characterized.

Methods

Men aged 50+ with nonmetastatic prostate cancer starting continuous ADT were enrolled in a prospective longitudinal study. BMD was determined by dual-energy x-ray absorptiometry at baseline and yearly for 3 years. Matched controls were men with prostate cancer not receiving ADT. Multivariable regression analysis examined predictors of BMD loss.

Results

Eighty ADT users and 80 controls were enrolled (mean age 69 years); 52.5 % had osteopenia and 8.1 % had osteoporosis at baseline. After 1 year, in adjusted models, ADT was associated with significant losses in lumbar spine BMD compared to controls (−2.57 %, p = 0.006), with a trend towards greater declines at the total hip (p = 0.09). BMD changes in years 2 and 3 were much smaller and not statistically different from controls. Use of vitamin D but not calcium was associated with improved BMD in the lumbar spine in year 1 (+6.19 %, p < 0.001) with smaller nonsignificant increases at other sites (+0.86 % femoral neck, +0.86 % total hip, p > 0.10) primarily in the first year.

Conclusions

Loss of BMD associated with ADT is greatest at the lumbar spine and in the first year. Vitamin D but not calcium may be protective particularly in the first year of ADT use.

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Acknowledgments

This study was funded by research grants from the Canadian Cancer Society. Dr. Alibhai is a research scientist of the Canadian Cancer Society. Dr. Cheung is supported by a senior investigator award from the Canadian Institutes of Health Research.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Medicine, University Health Network, Room EN14-214, 200 Elizabeth Street, Toronto, M5G 2C4, Ontario, Canada

    S. M. H. Alibhai, H. Z. Mohamedali, H. Gulamhusein, A. H. Panju, H. Breunis, N. Timilshina, M. D. Krahn, I. F. Tannock, G. Tomlinson & A. M. Cheung

  2. Geriatric Program, Toronto Rehabilitation Institute, Toronto, Ontario, Canada

    S. M. H. Alibhai

  3. Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    S. M. H. Alibhai, M. D. Krahn, G. Naglie, I. F. Tannock & A. M. Cheung

  4. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    S. M. H. Alibhai, M. D. Krahn, G. Naglie, I. F. Tannock & A. M. Cheung

  5. Division of Urology, University Health Network, Toronto, Ontario, Canada

    N. Fleshner

  6. Department of Medicine and Rotman Research Institute, Baycrest Geriatric Health Care Centre, Toronto, Ontario, Canada

    G. Naglie

  7. Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada

    G. Tomlinson

  8. Radiation Medicine Program, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada

    P. Warde

  9. Neurosciences Program, University Health Network, Toronto, Ontario, Canada

    S. Duff Canning

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  1. S. M. H. Alibhai
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  2. H. Z. Mohamedali
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  3. H. Gulamhusein
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  4. A. H. Panju
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  5. H. Breunis
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  7. N. Fleshner
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  8. M. D. Krahn
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  9. G. Naglie
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  10. I. F. Tannock
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  12. P. Warde
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  14. A. M. Cheung
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Corresponding author

Correspondence to S. M. H. Alibhai.

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Alibhai, S.M.H., Mohamedali, H.Z., Gulamhusein, H. et al. Changes in bone mineral density in men starting androgen deprivation therapy and the protective role of vitamin D. Osteoporos Int 24, 2571–2579 (2013). https://doi.org/10.1007/s00198-013-2343-4

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  • DOI: https://doi.org/10.1007/s00198-013-2343-4

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