Prostate-selective α antagonists increase fracture risk in prostate cancer patients with and without a history of androgen deprivation therapy: a nationwide population-based study
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Wei-Heng Kao1,*, Chang-Fu Kuo2,3,*, I-Jun Chou4, Lai-Chu See2,5,6, Wen-Kuan Huang7, Meng-Jiun Chiou2, Weiya Zhang3, Michael Doherty3, Chun-Chieh Wang1,9, Jun-Te Hsu8, Hsien-Hsin Chen1 and Ji-Hong Hong1,9,10
1Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
2Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
3Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
4Department of Paediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
5Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
6Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan
7Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
8Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
9Department of Medical Imaging and Radiological Science, Chang Gung University, Taoyuan, Taiwan
10Radiation Biology Research Center, Institute for Radiological Research, Chang Gung University/Chang Gung Memorial Hospital, Taoyuan, Taiwan
*These authors have contributed equally to this work
Keywords: prostate-selective α antagonists; prostate cancer; androgen deprivation therapy; fracture; population-based study
Received: May 13, 2017 Accepted: December 24, 2017 Published: January 02, 2018
Introductions: Prostate-selective α antagonists are recommended for relief of lower urinary tract symptoms in prostate cancer patients despite uncertainty of fracture risk as an addition to androgen deprivation therapy (ADT). The purpose of this study is to estimate fracture risk associated with these medications in prostate cancer patients who did and did not receive ADT.
Methods: The Taiwan National Health Insurance database was used to identify prostate cancer patients. We identified all 90-day person-quarters exposed to and not exposed to prostate-selective α antagonists. A generalized estimating equation model was used to estimated adjusted odd ratios (ORs) and 95% confidence intervals (CIs) for fracture associated with prostate-selective α antagonists with consideration for confounding by indication bias using propensity score.
Results: During 1997–2008, 16,601 persons received a diagnosis of prostate cancer, among whom 13,694 received ADT. Among prostate cancer patients receiving ADT, fracture was significantly more common in person-quarters with prostate-selective α antagonist use than in quarters without such treatment (OR, 1.08; 95% CI, 1.00–1.18). Prostate-selective α antagonist use was most strongly associated with femur fracture (OR, 1.22; 95% CI, 1.09–1.38), followed by skull fracture (OR, 1.29; 95% CIs: 0.93–1.80). Among patients who did not receive ADT, fracture was more common in person-quarters with prostate-selective α antagonist use than in those without medication use (OR, 1.19; 95% CI, 0.91–1.55).
Conclusions: Prostate-selective α antagonist is associated with an increased fracture risk, particular for fractures in skull and femur. Patients should be well-informed on this potential risk before taking prostate-selective α antagonists.
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