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The prevalence of vertebral fractures is high among men with prostate cancer at the start of androgen deprivation therapy (ADT), according to findings from a cross-sectional, real-world study in the Netherlands.

Despite a low prevalence of osteoporosis and sarcopenia as well as a low fracture risk prior to therapy initiation, one third of men with prostate cancer were diagnosed with a vertebral fracture following a spinal x-ray.

The findings underscore the importance of assessing patients for vertebral fractures at a baseline, before initiating ADT, given that this therapy is known to increase fracture risk, conclude the investigators, led by Marsha M. van Oostwaard, PhD, chinese medicine and magnets of VieCuri Medical Centre and Maastricht University Medical Center, the Netherlands.

The study was published last month in the Journal of Bone Oncology.

Guidelines from the European Society for Medical Oncology, the European Association of Urology, and other organizations call for fracture risk assessment for men with prostate cancer who are starting or receiving ADT, but fracture screening and prevention in this setting remain suboptimal despite the guidelines.

Given that ADT increases fracture risk and about half of patients with prostate cancer will receive it, van Oostwaard and colleagues set out to evaluate the fracture risk and the prevalence of osteoporosis, vertebral fractures, and sarcopenia in men with prostate cancer at the start of ADT.

At ADT initiation, 115 men with prostate cancer were assessed for comorbidities, medication use, and 10-year fracture risk between January 2019 and December 2020. The mean age of the men was 73.3 years, and they had been receiving ADT for a mean of 56.5 days (range, 22.5 to 90.5 days). All men underwent laboratory tests, dual-energy x-ray absorptiometry, and spinal x-rays.

Overall, five men (4.3%) had osteoporosis, and one had sarcopenia. The mean 10-year risk for major osteoporotic fractures and hip fractures was also low — 4.4% and 1.7%, respectively.

However, 41 (35.7%) had osteopenia, and bone mineral density (BMD) was normal in only 69 men (60%).

Most notably, 37 men (32.2%) had at least one moderate or severe vertebral fracture, and 39 men (33.9%) had at least one grade 2 or 3 vertebral fracture, osteoporosis, or both. In addition, at least one new fracture risk–associated metabolic bone disorder was identified by laboratory testing in 10.4% of patients.

“Although ADT can have significant benefits on survival, the evidence that ADT increases long term fracture risk is convincing,” van Oostwaard and colleagues explain.

The authors acknowledge limitations, such as the cross-sectional study design, possible selection bias, and the predominantly White study population, all of which may limit the generalizability of the findings.

Still, the results point to a need for better fracture risk assessment and management.

“Besides BMD measurement and fracture risk calculation using FRAX, a systematic vertebral fracture assessment should be considered in all men with [prostate cancer] at initiation of ADT to provide a reliable baseline classification of VFs to improve identification of true incident VFs during ADT,” the authors conclude.

Van Oostwaard has disclosed no relevant financial relationships.

J Bone Oncol. 2023;98:100465. Full text

Sharon Worcester, MA, is an award-winning medical journalist based in Birmingham, Alabama, writing for Medscape, MDedge and other affiliate sites. She currently covers oncology, but she has also written on a variety of other medical specialties and healthcare topics. She can be reached at [email protected] or on Twitter: @SW_MedReporter.

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