Lack of T and negative effect on bone health

[bedbt (imported)]

Here is a link to an article I ran across today.

http://www.chron.com/cs/CDA/ssistory.mp ... an/2990399

Local researchers have found that an increasingly popular prostate cancer therapy increases the risk of broken bones in older men, further complicating how best to treat the disease.

The study by the University of Texas Medical Branch at Galveston researchers blamed hormone-suppressing drugs for more than 3,000 fractures suffered every year by American men with prostate cancer. Such fractures often lead to death.

"This brings new information that doctors should discuss with their patients," said Dr. Vahakn Shahinian, a UTMB assistant professor of internal medicine and lead investigator of the study. "They should be aware that hormone-suppressing drugs carry a risk."

The study's findings were reported in today's New England Journal of Medicine.

Hormone-suppressing drugs reduce the level of male hormones such as testosterone, which help build bone and muscle but can also fuel the growth of prostate cancer cells. Combined with radiation, such drugs have been proved to save lives among men with advanced prostate cancer.

But over the past 15 years, hormone-suppressing drugs have been increasingly used in less aggressive, earlier stages of the disease, where there is no clear proof it helps, but some doctors and patients want to do something.

Prostate cancer kills about 30,000 men in the United States annually. Second only to skin cancer in frequency, it's diagnosed in 220,000 men a year.

Determining whether treatment is necessary is sometimes difficult. Nearly 50 percent of men diagnosed have the less aggressive, early-stage form that often never becomes fatal.

For the elderly, serious fractures can lead to slow-healing infections, confinement to nursing home beds and death. One-third of elderly men who break their hips die of complications within a year.

While experts have known that hormone-suppressing drugs are associated with a loss of bone density, its effect on fractures has been less clear.

To clarify that, Shahinian's team reviewed the records of nearly 51,000 prostate cancer patients 66 and older, from national databases on cancer and Medicare patients — the largest-ever study of the subject. They found the risk of fracture increased with the number of hormone-suppressing doses given.

Among the men who survived at least five years from the date of their diagnosis, 19.4 percent of those who received hormone therapy had a fracture, compared with 12.6 percent of those who didn't.

Those patients given nine doses in the year after their diagnosis were 45 percent more likely to suffer a fracture than those who didn't receive the treatment; those getting five to eight doses were 22 percent more likely; and those getting one to four doses were 7 percent more likely.

Those who got surgical castration, more common before the 1980s but still occasionally done, were 54 percent more likely to suffer a fracture.

The study also found that among men surviving five years after their diagnosis and getting hormone suppression therapy, the risk of a fracture requiring hospitalization doubled, compared with the group not getting the treatment. So did the risk of a spine, hip or upper leg fracture.

Doctors generally tell men about hormone-suppression therapy's other side effects: loss of muscle mass and strength, loss of some mental sharpness and hot flashes. But few have brought up the fracture risk until recently.

Shahinian said doctors who use hormone-suppressing drugs should monitor patients' bone mineral density and consider giving bisphosphonate drugs that can slow and sometimes reverse bone loss. Fosamax is an example of such a drug.

"There's no question hormone-suppression therapy is beneficial in advanced prostate cancer patients and those with aggressive tumors that haven't spread throughout the body yet," said Shahinian. "I understand the desire to do something in less aggressive early-stage cases even if there's no evidence it's helping, but now we know hormone suppression isn't benign. That's a risk-benefit discussion every doctor and patient should have."

The study is just the latest to raise questions about prostate cancer care. Earlier this year, a study found that many men told they do not have prostate cancer based on the result of the popular prostate-specific antigen test probably do have tumors. That caused uncertainties about how much to rely on the PSA test.

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[JeffEunuch (imported)]

The anti-androgen drugs suppress all androgen production, regardless of source. The old standard for treatment of prostate cancer before these drugs were available was often surgical removal of the testes. Castration's still the choice for many older men desirous of avoiding the other side effects of these drugs or, in the USA, without drug plans to pay for those drugs. Castration did not have any effect on T produced by other organs. Loss of testosterone - estrogen in women - makes one more likely to develop osteoporosis.

Does anyone know whether the effects of these modern drugs might lead to a greater tendency towards osteoporosis than castration?

I was castrated ~5 years ago. I ingest 5 mg of Androgel (testosterone) daily. I'm quite active physically. When last measured my bone density was 1.10 (110% of a 21 y.o. woman, the standard for bone density health).

[bibiribi (imported)]

This is food for thought. The emasculation require aftercare.

[Chris1115 (imported)]

This is food for thought. The emasculation require aftercare.

I recently read that chemical castration drugs have a higher incidence of bone density loss than surgical castration. That is why they are typically only used for a maximum of 24 months. They shouldn't be used as a long term solution without adequate forethought and bone density monitoring.

[daifu-orchid (imported)]

Seems that there are also accounts that eunuchs last longer. Maybe Korean study? A Distinguished Academic here will surely correct.

Does no-T castration do the bones no good? I guess good to get checked, as there are pictures and account of eunuchs at:

https://academic.oup.com/jcem/article-l ... 84.12.6206

Seems that it is very different for different folks. So pictures seem to show old people, while other show greatly affected appearance.

How effective is HRT at preventing bone fracture and damage? It seems to be good for retaining calcium in bones, but that is not the same as whether it actually makes bones stronger.

Consult the Doc for professional advice, and be safe!