Androgen Deprivation Therapy Increases Cardiovascular and Bone Risks in Veterans With Prostate Cancer

Key Takeaways

• A nationwide Veterans Affairs (VA) cohort study found androgen deprivation therapy (ADT) for prostate cancer increases risks of cardiovascular events, bone fractures, and osteoporosis across all racial groups.
• Among 790 916 veterans, hazard ratios for cardiovascular events, fractures, and osteoporosis were significantly elevated, though racial differences were minimal.
• Researchers conclude that race should not alter current recommendations for cardiovascular and bone monitoring in patients receiving ADT.

A large, nationwide cohort study published using Veterans Affairs Health Care System (VAHCS) data found that androgen deprivation therapy (ADT) for prostate cancer significantly increases cardiovascular and bone-related complications across all racial groups. The findings, drawn from more than 790 000 US veterans, were published in JAMA Network Open and highlight the importance of universal monitoring for adverse events among men undergoing ADT.

Study Findings

Researchers analyzed electronic health records of 790 916 veterans with prostate cancer between 2001 and 2021. Patients who received luteinizing hormone–releasing hormone agonists—leuprolide, goserelin, or triptorelin—had significantly higher risks of multiple adverse outcomes compared with those who did not receive ADT.

ADT use was linked to a 16% increased risk of cardiovascular events (HR 1.16; 95% CI, 1.15–1.17; P < .001), a 59% higher risk of bone fractures (HR 1.59; 95% CI, 1.55–1.62), and nearly a threefold increase in osteoporosis (HR 2.73; 95% CI, 2.65–2.80).

When stratified by race, all groups showed significant associations. Among Black veterans, ADT-related cardiovascular risk was slightly lower (HR 1.09) than among White veterans (HR 1.18), while osteoporosis risk was modestly higher (HR 3.16 vs 2.64). Despite these small variations, researchers emphasized that the clinical differences were minimal.

Clinical Implications

The study reinforces that ADT’s adverse effects on cardiovascular and bone health extend across racial boundaries. Because cardiovascular disease is a leading cause of death among men with prostate cancer, clinicians should implement vigilant monitoring for all patients receiving ADT—regardless of race.

Recommended strategies include controlling blood pressure and lipids, managing glucose levels, and encouraging regular exercise to mitigate cardiac risk. For bone health, clinicians should routinely assess bone mineral density, ensure adequate calcium and vitamin D intake, and consider pharmacologic interventions to prevent fractures and osteoporosis.

The VA’s equal-access model likely reduced racial disparities in outcomes, suggesting that equitable care delivery can help mitigate systemic health inequities seen elsewhere.

Conclusion

In one of the largest studies of its kind, VA researchers found that androgen deprivation therapy increases cardiovascular and bone risks among veterans with prostate cancer, with only minor racial differences. These findings support uniform cardiovascular and bone health monitoring for all patients receiving ADT in the US.

Reference

Friedrich NA, Janes JL, Parrish J, et al. Racial differences in adverse events after androgen deprivation in veterans with prostate cancer. JAMA Netw Open. 2025;8(11):e2545705. doi:10.1001/jamanetworkopen.2025.45705