Preexisting osteopenia and osteoporosis in men with prostate cancer are of concern due to accelerated bone loss during androgen deprivation therapy (ADT). We sought to identify risk factors for osteoporosis in men with prostate cancer who have not received ADT to help determine which patients may need bone mineral density (BMD) testing prior to ADT.
Lumbar spine and hip BMD testing were performed using dual-energy x-ray absorptiometry in 34 men with nonmetastatic prostate cancer who were not receiving ADT. The demographic, health status, lifestyle, and disease variables (Gleason score, clinical stage, and prostate-specific antigen level) were obtained and analyzed using univariate and multivariate methods for their role in spine and hip BMD levels.
Of the 34 men, 73.5% had osteopenia (55.9%) or osteoporosis (17.6%) of the spine and/or hip. On univariate analysis, aging, lower body mass index, and elevated prostate-specific antigen level correlated significantly with bone loss in the spine and hip. Regression models showed age independently predicted bone loss in the spine (R2 = 0.14). Prostate-specific antigen was an independent predictor of low BMD in the trochanter (R2 = 0.18), and body mass index independently predicted low BMD in the femoral neck (R2 = 0.19). Compared with men younger than 70 years old, men 70 years old or older had less BMD in the spine (P = 0.017), femoral neck (P = 0.047), and trochanter (P = 0.030).
A high prevalence of osteopenia or osteoporosis was found in men with prostate cancer not receiving ADT. Consideration should be given to performing BMD studies in men older than 70 years and with slender stature before initiating ADT.