Men's Osteoporosis Support Group

Depression and androgen deprivation therapy and osteoporosis

Osteoporos Int. 2009 Apr 3. [Epub ahead of print]. Depression and low bone mineral density: a meta-analysis of epidemiologic studies. Wu Q and others. PMID: 19343469. This is a meta-analysis involving 10,523 individuals in 14 qualified studies comparing the incidence of low bone mineral density in individuals with depression. Overall the investigators found a significant decrease in spine and hip BMD in those with depression. Those at greatest risk of low BMD were women and the clinically depressed. The authors concluded: "Depression should be considered as an important risk factor for osteoporosis."

Editor's comments. This study adds one more condition to the list of risk factors for osteoporosis. It is easy to imagine that those who are in clinical depression aren't paying attention to proper diet and exercise, getting adequate calcium and vitamin D intake, etc. So this relationship between depression and osteoporosis is quite logical. If you or someone you know is depressed, inform them of their added risk of osteoporosis so clinical diagnosis can be done to determine the status of their bone health. A depressed person doesn't need the added burden of a skeletal fracture to deal with.

BJU Int. 2009 Mar 10. [Epub ahead of print]. Long-term changes in bone mineral density and predicted fracture risk in patients receiving androgen-deprivation therapy for prostate cancer, with stratification of treatment based on presenting values. Wadhwa VK and others. PMID: 19338564. This study examined the long-term effects on BMD of two types of androgen deprivation therapy (ADT) in 618 men followed from October 1999 to January 2007. Therapies used were either luteinizing hormone-releasing hormone (LHRH) agonists or antiandrogen therapy with bicalutamide. Annual dual-energy X-ray absorptiometry (DXA) was done to determine changes in BMD in participants. The results showed, "In all, 41% of patients with newly diagnosed prostate cancer were osteoporotic, 39% were osteopenic and 20% had normal BMD." Additionally those men with normal BMD who got LHRH agonist therapy had a continual loss of BMD during the study period, up to a mean loss of 12.7% after six years. The men with osteopenia also received LHRH agonists which led to a continual loss of BMD during the study with a mean 11.5% loss after six years. However, the osteoporosis group got bicalutamide and had no additional loss of BMD during the study while showing an average 2.2% increase in BMD at the sixth year. The authors concluded, "Patients treated with an LHRH agonist have significant and sustained decreases in BMD, whereas bicalutamide maintains BMD. We advocate routine assessment of BMD before ADT, with surveillance thereafter."

Editor's comments. There are several articles on this site that cover research on prostate cancer and ADT, including this one. This is, however, the first I've heard of bicalutamide as an option for ADT therapy. Considering the very significant difference in loss of BMD in the men using LHRH agonists and those using bicalutamide, it behooves men with prostate cancer to be knowledgeable about the existence of and beneficial properties of this medication. They should mention it to their prostate cancer care provider and ask that it be considered for therapy. Also of great importance to men with prostate cancer is the finding that 80% of the men starting ADT therapy were either osteoporotic or osteopenic. This means those men need a referral to an osteoporosis specialist for diagnosis and possible therapy as part of their work up for ADT. Don't wait until a fracture occurs, prevention is a far better approach.

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