BoneKEy Reports | BoneKEy Watch

ADT in men with prostate cancer leads to osteoporosis and vertebral fractures

DOI:10.1038/bonekey.2012.252

A group of men (n=137) in their sixties or older, who had been undergoing androgen deprivation therapy (ADT) for at least 6 months as part of their treatment for prostate cancer, were assessed for skeletal deterioration in a cross-sectional study. Dual energy x-ray absorptiometry (DXA) was used to measure bone mineral density (BMD), while vertebral fracture assessment (VFA) was achieved by lateral spine imaging and high resolution microMRI (HR-MRI), which was used to examine the microarchitecture of the radius. Vertebral fractures (VFs) were confirmed by conventional x-ray analysis.

Mild VFs were detected in 30% of the men, while 7% had a VF that was moderate to severe. The majority of men with fractures (48/51) were unaware of them and 45% had two or more VFs. BMD measurements at the spine, total hip or femoral neck failed to detect osteoporosis in 47 out of 127 men who had a VF, a clear clinical sign of the disease.

Editor’s comment: ADT is a well-known major risk factor for fractures in men with prostate cancer. VFA is much more sensitive than DXA for identifying men with osteoporosis, as evidenced by the number of VFs detected. Microstructural alterations at the distal radius (as evaluated by HR-MRI) improved the sensitivity of DXA, allowing detection of moderate-to-severe VFs in these men.

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