Thirty-two studies (n=116,911, range 12 to 50,613) were included in the review: 70,684 patients had prostate cancer, 45,161 had prostate cancer and were being treated with hormone therapy, and 1,066 were healthy controls. A table of patient characteristics indicated that 51,605 patients with prostate cancer without hormone therapy and 26,082 patients with prostate cancer and treated with hormone therapy were included in the review.
Patients who received hormone therapy had lower total bone mineral density that patients who did not receive hormone therapy; levels were similar compared with healthy controls.
Risk of osteoporosis increased in patients with prostate cancer who were treated with hormone therapy compared to patients not treated with hormone therapy (adjusted RR 1.30, 95% CI 1.22 to 1.40, I2=36%; five studies). Compared to healthy controls, patients with prostate cancer without hormone therapy had a reduced risk of developing osteoporosis (adjusted RR 0.39, 95% CI 0.16 to 0.96, I2=0%; two studies). Patients who received hormone therapy had an increased risk (RR 2.26, 95% CI 1.00 to 5.09).
Incidence of fracture was significantly increased in patients who received hormone therapy compared to patients who did not (adjusted RR 1.17, 95% CI 1.14 to 1.20, I2=96%; five studies). Stratified analyses showed consistently increased risk of fracture in patients who received hormone therapy for all study characteristics assessed.
There was no evidence of publication bias.