Abstract 673P
Background
The use of androgen deprivation therapy (ADT) in prostate cancer can lead to long term changes in bone health and increased risk of osteoporotic events. In patients aged 65 years and over, the North East and Cumbria has the highest rate of emergency admissions for hip fracture in England. The fracture risk assessment (FRAX) tool can be used to predict the 10-year probability of hip fracture and other major osteoporotic fractures and subsequently guide patient management. This project aims to examine 1) the baseline risk of fracture in patients with prostate cancer commencing androgen deprivation therapy and 2) the long term ADT impact on changes of bone mineral density after 2 years of ADT and to establish local guidelines for bone health management in both metastatic and non-metastatic patient groups.
Methods
A prospective study of 111 patients who commenced ADT therapy at the Northern Centre for Cancer Care between 2016 and 2018 was performed. Data collected included patient demographics, the proposed duration of ADT and the additional prostate cancer treatments commenced. Patients underwent a baseline DEXA scan and the 10 year risk of fracture using the FRAX score was calculated. Additional bone protection commenced treatments post DEXA scan were recorded.
Results
A total of 111 patients were seen and commenced on ADT. Average age was 73 years. 72 patients (65%) had non-metastatic disease at presentation. The mean baseline FRAX 10-year probability was 4.2% for hip fracture and 9.6% for major osteoporotic fracture. 76% of the cohort had a calculated low risk FRAX score, 22% intermediate risk and 2% high risk. 7 patients in total were identified with having osteoporosis from baseline DEXA and 38 patients with osteopenia indicating reduced bone density at baseline.
Conclusions
This regional project has highlighted that patients with a calculated low 10 year risk of fracture may also have reduced baseline bone density. From FRAX score, 1 in 4 patients would require bone mineral density assessment; however, baseline DEXA scans in this cohort show that this is likely to be an underestimate. The plan (objective 2) is to now reassess this cohort and measure changes in fracture risk post ADT and additional prostate cancer treatments.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.