Abstract
Summary
Androgen deprivation therapy for prostate cancer can lead to osteoporosis and increased fracture risk. The Fracture Risk Assessment Tool (FRAX®) questionnaire can be used for risk stratification, and our study has demonstrated that the majority of men (91%) in our cohort commencing ADT for prostate cancer were considered low risk for future osteoporotic fracture.
Purpose/introduction
Long-term use of androgen deprivation therapy (ADT) in prostate cancer patients results in increased bone turnover and decreased bone mineral density (BMD). Proper assessment of any existing osteoporotic fracture risk is crucial prior to starting treatment. However, this risk assessment is poorly performed in these patients in spite of available validated tools including the Fracture Risk Assessment Tool (FRAX®). The objective of this study was to assess the distribution of osteoporotic fracture risk in a cohort of men commencing ADT for prostate cancer using the FRAX® algorithm.
Methods
Between July 2020 and May 2022, 200 men filled in the FRAX® questionnaire just before ADT. They were stratified into the high-risk (> 20% probability of a MOF over the next 10 years), intermediate-, and low-risk categories for fragility fractures. We also measured their serum vitamin D and calcium levels.
Results
The average age was 73.5 years (54–89). It took less than 10 min to complete the assessment. Only six patients were at high-risk, were started on bisphosphonates immediately, and referred for a dual energy X-ray absorptiometry (DEXA) scan. Twelve patients in the intermediate-risk category were referred for DEXA scans for bone mineral density measurements. A total of 182 patients (91%), were in the low-risk category and given lifestyle advice only. All had normal calcium levels but 134 (67%) patients, mostly in the low-risk category, had reduced vitamin D levels (< 50 nmol/L).
Conclusion
The FRAX® questionnaire is simple and immediately identifies patients who are at risk of fragility fractures. Our study has demonstrated that the majority of men (91%) in our cohort commencing ADT for prostate cancer were considered low risk for future osteoporotic fracture. We were surprised that more than half of our patients had low vitamin D levels.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Smith MR, Brown GA, Saad F (2009) New opportunities in the management of prostate cancer related bone complications. Urologic Oncol: Seminars Original Inv 27:S1-20
Pradhan M, Mandhani A, Chipde S, Kumar J, Ansari MS, Srivas- tava A, et al. Bone mineral densitometry at the time of instituting androgen deprivation therapy in metastatic prostate cancer: does practice pattern match the guidelines? Indian J Urol 2012: S72
Resnick MJ, Lacchetti C, Bergman J, Hauke RJ, Hoffman KE, Kungel TM et al (2015) Prostate cancer survivorship care guideline: American Society of Clinical Oncology Clinical Practice Guideline endorsement. J Clin Oncol 33:1078–1085
National Institute for Health and Clinical Excellence (NICE). Prostate cancer: diagnosis and management. NG131. London, UK: 2019
NCCN Clinical Practice Guidelines in Oncology. Prostate Cancer Version 2.2020. Page46
National Osteoporosis Guideline Group. NOGG 2017: clinical guideline for the prevention and treatment of osteoporosis 2017
Mottet N, Bellmunt J, Briers E, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. 2016
Hoff M, Meyer HE, Skurtveit S et al (2017) Validation of FRAX and the impact of self- reported falls among elderly in a general population: the HUNT study, Norway. Osteoporos Int 28:2935–2944
James H 3rd, Aleksic I, Bienz MN, Pieczonka C, Iannotta P, Albala D et al (2014) Comparison of Fracture Risk Assessment Tool score to bone mineral density for estimating fracture risk in patients with advanced prostate cancer on androgen deprivation therapy. Urology 84:164–168
Adler RA, Hastings FW, Petkov VI (2010) Treatment thresholds for osteoporosis in men on androgen deprivation therapy: T-score versus FRAX. Osteoporos Int 21:647–653
Physician’s Guide to Prevention and Treatment of Osteoporosis. National Osteoporosis Foundation; Washington D.C.: 2008
Ross AC, Manson JE, Abrams S, The, et al (2011) report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 96(2011):53–58
J.A. Kanis, N.C. Harvey, C. Cooper, H. Johansson, A. Odén, E.V. McCloskey, A systematic review of intervention thresholds based on FRAX: a report prepared for the National Osteoporosis Guideline Group and the International Osteoporosis Foundation, Arch. Osteoporos. 11 (1) (2016)
Saylor PJ, Kaufman DS, Michaelson MD, Lee RJ, Smith MR (2010) Application of a fracture risk algorithm to men treated with androgen deprivation therapy for prostate cancer. J Urol 183:2200–2205
Neubecker K, AdamsHuet B, Farukhi IM, Delapena RC, Gruntmanis U (2011) Predictors of fracture risk and bone mineral density in men with prostate cancer on androgen deprivation therapy. J Osteoporos 2011:924595
Lowey H. Public Health Annual Report. The health and well-being of Bolton – an overview. February 2021. Accesed here: [https://www.boltonccg.nhs.uk/media/6582/public-health-annual-report-201920-merged.pdf on 09/09/2022]
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Level of evidence according to the Oxford Centre for evidence-based medicine levels of evidence (March 2009): 2b.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Sharqawi, A., Hewitt, K., Alexander, C. et al. Improving bone health in prostate cancer patients starting androgen deprivation therapy: does Fracture Risk Assessment Tool (FRAX®) enhance stratification and targeted management?. Arch Osteoporos 17, 143 (2022). https://doi.org/10.1007/s11657-022-01185-8
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s11657-022-01185-8