Does androgen-receptor inhibitor therapy increase the risk of falling and broken bones in patients with prostate cancer?

This study investigated if treating patients who have prostate cancer with androgen receptor inhibitors (ARIs) increased their risk of falling and breaking their bones. The study found that patients who received ARI were more likely to have a fall or fracture compared to other treatments.

Prostate cancer (PCa) is the uncontrolled growth and division of prostate cells. One factor that influences the growth of prostate cancer is androgens (male sex hormones such as testosterone). Androgen deprivation therapy (ADT) reduces the production of androgens and is the standard care for advanced PCa. Another treatment option for patients with advanced PCa includes ARIs. ARIs block the activity of the male hormones (such as testosterone) to stop tumor growth. Enzalutamide (Xtandi), apalutamide (Erleada), and darolutamide (Nubeqa) are ARIs commonly used in therapy.

The risk of falling and suffering an injury such as a fracture (broken bones) is high amongst patients with advanced-stage PCa. ARI therapy has been associated with a higher risk of falling and fractures in patients with cancer. However, the link between ARI therapy in PCa and the risk of falling or fracture is not clear.  

This study reviewed 11 other studies that included 11,382 patients with PCa. 6536 patients were treated with ADT + ARI. 4846 patients were given ADT+ placebo. ARI treatment involved enzalutamide, apalutamide, or darolutamide. The occurrence of falls and/or fractures was evaluated.

Patients who received ARI therapy were 80% more likely to report a fall and 60% more likely to report a serious fall compared to patients who did not receive ARIs. These patients were also 59% more likely to suffer from a fracture and 71% more likely to suffer from a serious fracture.

This study showed that treating patients with ARIs increased their risk of falling or suffering a fracture. The authors suggest a careful screening of patients at risk of falling and using bone-targeted medications in these patients. 

There was no analysis of factors that could have influenced fall risk or if patients received bone-targeted medications. These factors could have influenced the results.

If you have concerns regarding ARIs, please discuss this with your doctor.