Prostate treatment and hip fracture

A standard treatment for advanced prostate cancer is to suppress testosterone production by removal of the testes. Men who undergo the procedure face an increased risk of hip fractures due to the bone-thinning disease osteoporosis. Researchers from the Karolinska Institute, Sweden, used population-based registries in Sweden to examine the rate of bone fractures in more than 17,000 men diagnosed with prostate cancer who underwent testicular removal. Fractures of the hip were most common and the men also had double the normal rate of fractures of the spine, pelvis, thigh, and lower leg. Twelve percent of men treated with castration had hip fractures in the 10 years following diagnosis, compared with a 5-percent rate over 10 years among men free of prostate cancer. On the other hand, prostate cancer patients who did not undergo the procedure had a hip fracture rate only slightly higher than that of men without prostate cancer.
Hip fracture risk increases almost immediately following the surgical removal of the testicles and the excess risk persists for at least 15 years. This side effect should be considered when assessing the merits of androgen deprivation therapy, particularly in symptom-free men diagnosed with prostate cancer. Measures to prevent osteoporosis should be considered in men undergoing androgen deprivation therapy.

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