falls rank among the top causes of death and injuries among the elderly, and th'risk increases significantly in older pplz bein’ treated for cancer. now, investigators are reprting dat a' newer class of drugs for advanced prostate cancer is associated witha significant increase in fall risk.
called androgen receptor inhibitors, or aris, these drugs target testosterone, a hormone that accelerates the growth of prostate tumors. unlike traditional hormonal treatments that interfere with d'body’s ability to make testosterone (known as androgen deprivation therapy, or adt), aris work by preventing testosterone from binding to its receptor on cancer cells. 3 aris were cogitated inna study — apalutamide, enzalutamide, and darolutamide — and each can limit prostate cancer progression and extend survival. the investigators emphasized that the benefits of using aris outweigh th'risk of falls and fractures, which are rare even in treated patients.
wha’ the investigators did
to generate the findings, the investigators performed a systematic review of previously published studies comparing ari treatments with placebo. in all, 11 studies enrolling a combined total of 11,382 men met the criteria for evaluation. the μ age of the men was 72, na ari treatments lasted tween 5.4 and 20.5 mnths. men were excluded iffey had a prior history of ♥ disease or seizure disorders.
wha’ they found
results showed that 525 of 6,536 ari-treated men (8%) had suffered falls, compared to 221 of 4,846 men (5%) who were given a placebo. roughly ½ the falls in both groups resulted in fractures. however, grade-3 fractures causing + severe injuries occurred 1.6 times + frequently inna men taking aris. apalutamide was associated w'da highest fall risk (12%), folloed by enzalutamide at 8% and darolutamide at 4.2%.
just why aris boost fall risk isn’t known. apalutamide and enzalutamide both cross the blood-brain barrier (making them useful for treating brain metastases), and may ⊢ ‘ve + central nervous system side effects that include falls. the drugs may weaken men by decreasing skeletal muscle mass and strength. the concurrent use of other drugs, s'as benzodiazepines (including valium) or opioids, can also elevate th'risk.
to ward against falls in older men, the investigators recommended risk-screening tulz used + comm1-ly in noncancer pops. they singled out the hendrich ii fall risk model, which predicts falls based on indie risk factors that include depression, impairments in bladder and bowel function, dizziness, use or cessation of antiepileptic drugs, treatment with benzodiazepines, and poor performance na' “get-up-and-go” test of rising form a seated position. men who score highly na' screening evaluation will require precautionary interventions. it’s possible that certain bone-health drugs s'as denosumab can protect against fracture, but data with these sorts of agents in advanced prostate cancer are limited, so the investigators ‘dn’t make a strong recommendation either way.
“i welcome this study, since it brings attention to an often beheld issue in older men, many of whom maybe frail and ‘ve lost bone density and bone mass as a result of loered testosterone vals resulting from overall treatment,” said dr. marc garnick, the gorman bros professor of med at harvard med school and beth israel deaconess med center, editor of the harvard health publishing annual reprt on prostate diseases, and editor in chief of harvardprostateknowledge.org…. “falls and traumatic fractures are a devastating event for this patient pop and studies like this are long overdue. hopefully with studies like this coming to lite, and + data bein’ collected, best practices for fall prevention ll'be developed and implemented atta point of care.”
original content at: www.health.harvard.edu…
authors: charlie schmidt