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Osteoporosis screening using computed tomography for men with prostate cancer: results of a prospective study

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Abstract

Summary

We performed a prospective study using both FRAX and computed tomography to screen for osteoporosis in men undergoing radiation for prostate cancer. We found that implementing routine computed tomography (CT)-based screening was feasible in the setting of a prospective study, but the yield of osteoporosis identification was low in this population.

Purpose

Men with prostate cancer (PCa) are at increased risk of hip fracture for multiple reasons. Estimation of hip fracture risk with the FRAX tool is currently recommended, but FRAX alone may not identify a portion of men with osteoporosis. We hypothesized that adding bone mineral density (BMD) screening using CT to FRAX is feasible and would identify more men with osteoporosis.

Methods

Men with PCa scheduled to undergo CT simulation for radiation treatment were enrolled in a single-arm prospective study. The mean attenuation of the mid-L5 vertebral body trabecular bone (L5CT) was calculated on a single slice using the radiation simulation CT scan. The 10-year risk of hip fracture was calculated using the FRAX tool. Dual energy X-ray absorptiometry (DXA) was performed for men whose L5CT measurement was less than 130 Hounsfield units (HU).

Results

A total of 98 eligible men were enrolled and underwent FRAX and CT screening. The median 10-year risk of hip fracture was 1.1% and exceeded 3% in 16 cases; the median L5CT was 162.28 HU (range 55.6–526.1 HU). DXA scan was completed in 15 men who had L5CT < 130 HU but 10-year calculated hip fracture risk < 3%, 1 of whom was found to have osteoporosis (T-score ≤ −2.5).

Conclusions

Implementing CT-based BMD screening was feasible in the setting of a prospective study for men receiving radiation for PCa, but fewer cases than anticipated of osteoporosis were identified.

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Funding

Research reported in this manuscript was supported by the National Center for Advancing, Translational Sciences of the National Institutes of Health under award number UL1TR003096. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA

    Andrew M. McDonald, Eddy S. Yang & John B. Fiveash

  2. Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA

    Andrew M. McDonald & Smita Bhatia

  3. Division of Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA

    Kenneth G. Saag

  4. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA

    Emily B. Levitan & Nicole C. Wright

  5. Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA

    Soroush Rais-Bahrami

  6. Department of Pediatrics, Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, AL, USA

    Smita Bhatia

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  1. Andrew M. McDonald
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  2. Eddy S. Yang
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  3. Kenneth G. Saag
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Corresponding author

Correspondence to Andrew M. McDonald.

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This study was approved by the institutional review board at the University of Alabama at Birmingham, and all patients provided written informed consent before participating in the study.

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McDonald, A.M., Yang, E.S., Saag, K.G. et al. Osteoporosis screening using computed tomography for men with prostate cancer: results of a prospective study. Arch Osteoporos 15, 32 (2020). https://doi.org/10.1007/s11657-020-0711-1

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