FRAX ® assessment of men
treated with androgen
deprivation therapy for prostate
cancer
Rafal Turo
William Cross
BONE HEALTH IN PROSTATE CANCER
Prostate Cancer
Bone
metastases
Pain
Pathological fracture
Spinal cord compression
Palliative therapy (EBRT/Surgery)
Androgen
Deprivation
Hormone
therapy
Treatment induced osteoporosis
Fractures
Pain
Aim of this study was to estimate using the WHO FRAX tool the
fracture risk in men treated with ADT for prostate cancer
THE WHO FRAX TOOL
 Add screen shot
METHODS AND RESULTS
Methods
 Prospectively evaluated 90 men treated with ADT for prostate
cancer
 Fracture risk estimated using WHO FRAX online tool
Results
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Mean age 76.2 years (range: 56 -90)
Bone metastases were present in 46%
6.7% had a history of a fracture
11% were smokers
10-year hip fracture risk by FRAX (%)
The 3% hip fracture risk threshold for preventative
treatment was exceeded by 66.7% of men
The treatment threshold was exceeded by:
23.8% of those younger than 70 years
63.9% of those 70 to 79 years old
97 % of those 80 years old or older
>3% risk
Age (years)
10-year hip fracture risk by FRAX (%)
The 3% hip fracture risk threshold for preventative
treatment was exceeded by 10% of men
>3% risk
Age (years)
CONCLUSIONS
 In this cohort of men the WHO FRAX ® calculated risk of
fracture was clinically significant
 National guidelines are required for bone health assessment
and prophylactic therapy in men with prostate cancer
managed with androgen deprivation therapy
WA D H WA , V. K . , W E S T O N , R . , & PA R R , N . J . ( 2 0 0 9 ) . F R E Q U E N C Y O F Z O L E D R O N I C AC I D T O
P R E V E N T F U R T H E R B O N E LO S S I N O S T E O P O R O T I C PAT I E N T S U N D E R G O I N G A N D R O G E N
D E P R I VAT I O N T H E R A P Y F O R P R O S TAT E C A N C E R B J U I N T E R N AT I O NA L
FRACTURE INCIDENCE ON ADT
5 years after diagnosis of prostate cancer, 19.4 % of those who
received ADT had a fracture, as compared with 12.6 % of those
not receiving ADT (n=50613)
S h a h i n i a n , V. B . , e t a l . , R i s k o f f r a c t u r e a f t e r a n d r o g e n d e p r i v a t i o n f o r p r o s t a t e c a n c e r. N E n g l J
Med, 2005. 352(2): p. 154-64.
Reported a fracture incidence of 28% after 7 years ADT (n=26)
D a n i e l l , H . W. , e t a l . , P r o g r e s s i v e o s t e o p o r o s i s d u r i n g a n d r o g e n d e p r i v a t i o n t h e r a p y f o r p r o s t a t e
c a n c e r. J U r o l , 2 0 0 0 . 1 6 3 ( 1 ) : p . 1 8 1 - 6 .
BONE HEALTH CLINIC PATHWAY
Osteoporosis
ALL patients
Non-pharmacological
management
ALL patients
Clinical evaluation
-prevention of falls
through weight bearing
exercise and home
safety counseling
- smoking cessation
- avoidance of excess
alcohol
- adequate oral intake
of Ca and vit D
-medical history to look
for risk factors and
secondary causes of
osteoporosis
- Measurement of 25hydroxyvtamin D so that
the level can be
increased to 30ng/ml
- FRAX risk calculation
HIGH RISK
patients:
DEXA scan
Treatment of osteoporosis:
- Alendronate
- Pamidronate
- Zolendronic acid
- Denusomab
Osteopenia
Repeat BMD after 6 to 12
months
Normal BMD
Repet BMD after 2 years