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Poster Display session 3

2134 - Baseline fracture risk in men with prostate cancer starting the STAMPEDE trial


30 Sep 2019


Poster Display session 3


Tumour Site

Prostate Cancer


Janet Brown


Annals of Oncology (2019) 30 (suppl_5): v325-v355. 10.1093/annonc/mdz248


J.E. Brown1, C. Handforth2, J. Walsh3, C. Pezaro3, M.R. Sydes4, N.W. Clarke5, N.D. James6, E. McCloskey3

Author affiliations

  • 1 Oncology And Metabolism, Academic Unit Of Clinical Oncology, University of Sheffield, S10 2SJ - Sheffield/GB
  • 2 Academic Unit Of Clinical Oncology, University of Sheffield, S10 2SJ - Sheffield/GB
  • 3 Oncology And Metabolism, University of Sheffield, S10 2SJ - Sheffield/GB
  • 4 Institute Of Clinical Trials & Methodology, MRC Clinical Trials Unit at UCL, WC1V 6LJ - London/GB
  • 5 The Departments Of Surgery And Urology, The Christie and Salford Royal Hospitals, Manchester/GB
  • 6 Clinical Trials Unit, Queen Elizabeth-University Hospital Birmingham NHS Foundation Trust, B15 2TH - Birmingham/GB


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Abstract 2134


Androgen deprivation therapy (ADT) for prostate cancer (PC) increases fracture risk. In non-cancer populations, FRAX, a fracture risk assessment tool, is used routinely to calculate 10-year probability of major osteoporotic fracture (MOF; spine/hip/forearm/humeral fractures) and hip fracture alone to determine the need for bone density (BMD) assessment and/or treatment. We calculated FRAX using risk factors at entry to the large STAMPEDE PC study.


STAMPEDE includes men with newly diagnosed metastatic/high risk non-metastatic PC about to commence ADT, randomised to add or substitute other therapies. Our pre-planned analysis included 6379 men, 86% of enrolment at the time of analysis (2018) for whom FRAX clinical risk factors (excluding femoral neck BMD) were collected prospectively. Secondary osteoporosis in FRAX was set to ‘yes’ for all, as they were about to receive ADT. Glucocorticoid use was set to ‘yes’ for men allocated to abiraterone due to potentially long concomitant use, but not for those allocated shorter treatment with docetaxel.


Baseline characteristics for this largest dataset of its kind, are shown below. The mean (SD) baseline FRAX 10-year probability was 3.06(2.96)% for hip fracture and 8.70(4.02)% for MOF. Risk increased with increased age at entry, eg MOF probability at age 50-54 years was 4.9% rising to 11.3% in those aged 75 years or older. Using UK National Osteoporosis Guideline Thresholds, 2221 (34.8%) men were classified as high/intermediate risk (meriting BMD scan).The need for BMD assessment varied across planned treatment arms (18.4% in men receiving ADT only to 80.0% in men also planned to receive abiraterone).Table:


Randomisation years2006- 2018
Age (y)67.4±7.2
Height (cm)174.7±6.9
Weight (kg)85.6±14.8
BMI (kg/m2)28.0±4.5
Prevalence of FRAX risk factors (%) Previous fracture after age 50yr6.1
Glucocorticoid use (≥4 mo)27.4
Parental hip fracture7.7
Rheumatoid arthritis2.4
Alcohol (≥3 units daily)15.5
Current smoking11.5


FRAX fracture risk assessment in men starting ADT suggests 1 in 3 require BMD assessment to decide on the need for bone protection. Planned treatment in addition to ADT, rather than age, was the main determinant for consideration of bone health.

Clinical trial identification


Editorial acknowledgement

Legal entity responsible for the study

University of Sheffield.


University of Sheffield.


J.E. Brown: Honoraria (self), Research grant / Funding (institution): Amgen; Honoraria (self), Research grant / Funding (institution): Novartis; Honoraria (self), Research grant / Funding (institution): Bayer; Honoraria (self): BMS; Honoraria (self): Daiichi-Sankyo; Honoraria (self): Ipsen; Honoraria (self): Sandoz; Honoraria (self): Merck Sharpe Dome. All other authors have declared no conflicts of interest.

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