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Early intervention with a bone mineral density screening may help prevent major fractures in older men with prostate cancer who are treated with androgen deprivation therapy (ADT), a new study finds.

ADT is commonly used to treat prostate cancer in this population, but low androgen is also a common secondary cause of osteoporosis in men. The findings highlight the importance of performing dual X-ray absorptiometry (DXA) scans to determine baseline bone density and fracture risk in these patients, the authors said.

The investigators followed outcomes in nearly 55,000 men with prostate cancer aged 66 years or older. All had begun cancer treatment with androgen deprivation therapy. Rates of bone density screening were low, at only 7.9%, the researchers found. The lowest rates were among men who were Black, single, had lower educational levels and/or lived in socioeconomically deprived areas.

Fully 17% of the study participants experienced any type of fracture, and 7.7% developed a major osteoporotic fracture. But men who received a DXA scan had a significantly decreased risk of developing major osteoporotic fractures after adjustment for other variables, reported Maria Suarez-Almazor, M.D., Ph.D., of the University of Texas MD Anderson Cancer Center in Houston.

Ideas for prevention

Strategies are needed to encourage clinicians to follow current guidelines for bone health management in these men, Suarez-Almazor and colleagues proposed. In addition, drug interventions could further help to prevent the morbidity and mortality associated with secondary fractures linked to ADT, they said.

In an accompanying editorial, Amar U. Kishan, M.D., of the University of California, Los Angeles, and colleagues proposed a few simple solutions for clinicians. Vitamin D and calcium supplements could help retain bone strength, they suggested. The osteoporosis drug denosumab could also be used in certain cases, they added.