4913 - Prostatic cancer androgen deprivation therapy and bone health in carcinoma prostate.

Background

Patients with carcinoma prostate undergo rapid decline in bone health as measured by bone mineral density in the first 6 to 12 months of treatment with androgen deprivation. The WHO has developed the FRAX (Fracture Risk Assessment) Tool to predict long-term risk of major fractures and hip fracture. Guidelines are available for managing therapy related osteoporosis. This study is to characterize the risk (based on the FRAX tool) and management on the basis of guidelines in view of non-availability of bone matrix density assessments on basis of DEXA Scan.

Methods

A retrospective analysis of 196 consecutive patients receiving LHRH agonists at a single practice for the period of 2010 to 2018 was done. Data was collected after IRB clearance and included demographics, medical history, treatment history, history of ADT, bone health and its management. 10y fracture risk was calculated using the FRAX tool. Descriptive statistics were used for demographic analysis and to characterise the management of bone health. Paired t-Test was used to compare 10y fracture pre and post ADT.

Results

A total of 196 patients were seen. The mean age was 65.5y. 36% patients had Stage II disease and 56% had Stage III disease. All patients had PSA >10 and a Gleason Score >7 and Life expectancy <10y. 97% patients received LHRH agonists for a mean period of 13.8 + 18.1 months. 57% patients had >2 Risk for osteoporosis. Counselling for adverse effect of ADT and bone side effects was seen in 20% of patients. Bone health assessment was not available for 75% of patients. Bisphosphonate therapy was seen in 3% of patients. The risk of sustaining a major fracture increased from 26% to 34% (P < 0.001) on initiation of ADT. The risk of sustaining a hip fracture rose from 12% to 20%. Guidelines was followed for DEXA Scan, Calcium supplements and Vitamin D in 22%, 15%, and 8% respectively.

Conclusions

In addition to predisposing factors of osteoporosis, ADT increases risk of fracture in patients with ca prostate. There is room for improvement by increasing health literacy in multi-disciplinary team and Care providers. This is the first paper of its kind in developing countries including quality practice audit.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

G S Bhattacharyya.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.