ADT for advanced prostate cancer increases risk of bone fractures, says new study

Nov 01, 2023
ADT for advanced prostate cancer increases risk of bone fractures, says new study

Androgen deprivation therapy (ADT), used to treat prostate cancer, has a significant association with increasing a man’s risk for bone fractures, according to a large population-based study published in PLOS ONE. More than 13,000 men, with a mean age of 74.4 and newly diagnosed with prostate cancer, were included in this study from the Taiwan National Health Insurance Research Database. 

An interesting finding from the study was that men who underwent a surgery called orchiectomy had a 95% increased risk for bone fractures. 

What are ADT and orchiectomy?

Androgen deprivation therapy is a hormone therapy that reduces levels of male hormones, primarily testosterone and dihydrotestosterone (DHT), called androgens, that can fuel the growth of prostate cancer cells. A man’s testicles make most androgens; the adrenal glands and even prostate cancer cells can also make androgens. 

The decision to use ADT is based on several factors:

  • If prostate cancer has spread and is not treatable with surgery or radiation
  • If prostate cancer has returned after surgery or radiation
  • To shrink the cancerous tumor to make radiation treatment more effective

ADT drugs use luteinizing hormone-releasing hormone (LHRH) agonists to reduce testosterone made by the testicles. This type of treatment is called medical castration but without the removal of the testicles. Over time, the testicles will shrink. 

There is another type of ADT that is a surgical castration called orchiectomy. The testicles are removed, which is where most androgens are made. Removal of the testicles will result in most prostate cancers to stop growing. Since the surgery is a permanent removal of the testicles, some men may choose LHRH drug ADT instead. 

However, orchiectomy is an outpatient procedure, is less expensive than LHRH agonists, and is the simplest form of hormone therapy. 

Study findings

The researchers with this study found that men who used injectable forms of ADT had a significantly (55%) higher risk of developing bone fractures compared to a control group of men without prostate cancer. Conversely, men who used oral antiandrogens had a lower yet significantly increased risk of 37%.  

However, the most concerning finding were the men who had chosen orchiectomy to slow their advanced prostate cancer. These men had a 95% increase in experiencing bone fractures.

Another important finding in the men with advanced prostate cancer was that older men and men with several comorbidities – stroke, heart failure, and pulmonary and renal disease – also had a significantly increased risk for fractures of 15%, 24%, 22%, and 33%, respectively.

The study also found that men with a radical prostatectomy had a significantly 49% lowered risk of bone fractures. In addition, men prescribed osteoporosis medications, shown a 74% reduced risk of bone fractures. 

Takeaway message

This study found that all types of ADT increased the risk of bone fractures compared to men who only underwent prostatectomy. Among the different types of ADT, orchiectomy had the highest fracture risk. It also showed that a man’s age and having multiple comorbidities could increase the risk of bone fractures in prostate cancer patients. 

This is not the first time a study has proved the relationship between bone fracture risk and the use of ADT in men with prostate cancer. For example, in 2005, a study found that 19.4% of men using ADT for prostate cancer had a fracture compared to 12.6% of men not using ADT. A 2021 study also found that men with prostate cancer treated with ADT had a lower bone mineral density that could lead to thinning bones and bone fractures. 

The main take away from this study is that doctors caring for men with advanced prostate cancer who have chosen ADT or orchiectomy to slow the progression should properly monitor and provide osteoporosis medication to help reduce the risk of bone fractures. 


Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.