BONE HEALTH ASSESSMENT AMONG PROSTATE CANCER PATIENTS TREATED WITH ANDROGEN DEPRIVATION THERAPY IN A TERTIARY CENTRE IN MALAYSIA

Abstract

INTRODUCTION/BACKGROUND
Androgen deprivation therapy (ADT) is the cornerstone of treatment for castration-sensitive Prostate Cancer (PCa). However, the use of ADT can negatively impact bone health. This study aims to assess the prevalence of osteoporosis and osteopenia in men with PCa who have undergone ADT and identify any potential factors associated with osteoporosis among this population.

METHODOLOGY
This single-centre, cross-sectional study recruited 107 PCa patients treated with ADT at the Urology Unit, Hospital Sultanah Bahiyah from January 2020 to August 2023. Data collected included socio-demographics, comorbidities, treatment details and FRAX scores. Patients underwent Dual-energy X-ray absorptiometry (DEXA) scans and blood investigations including renal and liver function, serum calcium, vitamin D, testosterone and oestradiol levels. Osteoporosis-associated factors were identified using logistic regression and adjusted with confounders.

RESULTS
Our patients had a mean age of 73.1 years old (SD 7.2), with 62.6% being Malay (n = 67) and a mean BMI of 24.96 (SD 4.31). Among PCa patients treated with ADT, the prevalence of osteoporosis was 57.9% (n = 62), osteopenia was present in 39.3% (n = 42), and only 2.8% (n = 3) had normal bone mineral density. The most vulnerable site was the 1/3 radius with the highest osteoporosis prevalence of 43% (n = 46), followed by femoral neck at 29% (n = 31), lumbar spine at 22.4% (n = 23), and total hip at 11.2% (n = 12). Several predictive factors of osteoporosis were identified, including the absence of calcitriol usage (Adjusted Odd Ratio (AOR) = 5.07, CI 1.04-24.75, p = 0.04), duration of ADT (AOR = 1.02, CI 1.0-1.04, p = 0.03), and ongoing ADT (AOR = 5.08, CI 1.169-22.09, p = 0.03). In contrast, a higher weight conferred a lower risk for osteoporosis (AOR = 0.957, CI 0.92-0.99, p = 0.01).

CONCLUSION
This study highlights the importance of screening for osteoporosis in men who are undergoing ADT for PCa. Peripheral BMD is an effective tool to assess their bone health. Various risk factors, such as being underweight, not receiving calcitriol, continuous ADT, and longer treatment duration, can increase the likelihood of osteoporosis.