Because ADT can cause a loss of bone mineral density, men on ADT have an increased risk of bone fractures. However, if one is aware of the risks and takes appropriate action, this risk can be managed. Here the old adage, ‘knowledge is power,’ is surprisingly relevant.
Dual-energy x-ray absorptiometry (DXA, also abbreviated DEXA) screening is used to assess bone mineral density and is the standard tool for monitoring bone health. Yet, despite ADT’s risk to bone density, research suggests that DXA screening is under-utilized.
A recent study out of the United States looked at the rates of DXA screening among men with localized/regional prostate cancer who were starting ADT. The researchers used data from a national health database to examine rates of DXA screening among nearly 55,000 men (66-99 years of age), who were initiating ADT.
Only 7.9% of men underwent DXA screening shortly before or after starting ADT.
Subsequently while on ADT, 17.5% of men developed a bone fracture, and 7.7% of the men developed a major osteoporotic fracture. Of note, this study excluded men with metastatic disease, in order to rule out fractures related to bone metastases.
Importantly, DXA screening was associated with a 9.1% lower risk of major fracture among those who underwent DXA screening versus those who didn’t. It’s likely there are multiple factors contributing to this result, but the authors note: “Men who received DXA screening were more likely to receive bone-modifying agents (18.8%) than those who did not (1.8%).”
It may also be true that getting a DXA scan educates/informs (i.e., "sensitizes") patients to the osteoporotic risk of ADT. Patients may thus be more inclined to do exercises (e.g., impact loading exercises) and take medication, if prescribed, to protect their bones. In that sense, the DXA diagnostic procedure ends up being not just diagnostic, but having therapeutic value in and of itself.
To read the full article, see: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790600
Reference:
Suarez-Almazor ME, Pundole X, Cabanillas G, et al. Association of Bone Mineral Density Testing With Risk of Major Osteoporotic Fractures Among Older Men Receiving Androgen Deprivation Therapy to Treat Localized or Regional Prostate Cancer. JAMA Netw Open. 2022;5(4):e225432. Published 2022 Apr 1. doi:10.1001/jamanetworkopen.2022.5432