Clinical Edge

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Fracture risk in prostate cancer survivors

Key clinical point: This study found an overall higher risk of fracture in prostate cancer (PC) survivors, and the risk differed depending on the primary treatment method. Survivors who underwent surgery showed a lower risk and those treated with androgen deprivation therapy (ADT) showed a higher risk than the other PC treatment groups or the general population.

Major finding: PC survivors had a higher risk of fracture (adjusted hazard ratio [aHR], 1.39) vs. matched controls. Compared with general population, PC survivors who underwent active surveillance/watchful waiting (aHR, 1.08) or radiotherapy (aHR, 1.04) were at a similar risk of fracture and those who underwent surgery showed a lower risk (aHR, 0.89). PC survivors treated with surgery + ADT (aHR, 1.41), radiotherapy + ADT (aHR, 1.86), and only ADT (aHR, 1.92) showed a higher risk of fracture vs. the control group.

Study details: This retrospective longitudinal cohort study included 41,733 PC survivors newly diagnosed with PC between 2007 and 2013 and 170,736 matched non-cancer controls using the Korean National Health Insurance Service database.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.


“As patients with prostate cancer continue to live longer, attention is being paid to survivorship. Many studies, but not all, in patients with prostate cancer have suggested that risk of fracture may be increased for certain prostate cancer patients. Patients undergoing androgen deprivation treatment (ADT) appear to be at higher risk, but the association between other treatment modalities and fracture risk has not been studied as extensively.

Shin et al. utilized a national database to compare fracture risk in prostate cancer patients with matched controls in groups selected by treatment modality. They identified that, compared to controls, patients undergoing active surveillance or watchful waiting had a similar fracture risk, patients undergoing surgery had a lower fracture risk, and patients undergoing ADT (with or without surgery or radiation) had a higher risk. This retrospective study provides additional evidence that attention should be paid to the bone health of patients undergoing ADT.”

Mark Klein, MD


Shin HB et al. Arch Osteoporos. 2020 Jul 22. doi:10.1007/s11657-020-00785-6.