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Assessment of bone health in patients with prostate cancer using cancer staging computed tomography

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Abstract

Purpose

To evaluate the utility of vertebral Hounsfield unit (HU) values from computed tomography (CT) in cancer staging as a supplementary screening tool for bone health among prostate cancer (PCa) patients.

Methods

T-scores of bone mineral density (BMD) in each lumbar vertebra (L1–L4) and hip for newly diagnosed PCa patients (N = 139) were measured using dual-energy X-ray absorptiometry (DXA). The degenerative changes in each lumbar vertebra were assessed, and the HU values of trabecular bone in axial CT images of each vertebral body (vertebral CT-HU value) were measured using staging CT.

Results

556 vertebrae were analyzed. 326 of 556 (59%) lumbar vertebrae had degenerative changes. The vertebral CT-HU value was positively correlated with the lumbar BMD T-score, with higher correlation coefficients observed in vertebrae without degenerative changes (r = 0.655, N = 230) when compared to vertebrae with degenerative changes (r = 0.575, N = 326). The thresholds matching BMD T-scores of − 2.0 and − 1.5 set by cancer treatment-induced bone loss guidelines were 95 HU and 105 HU, respectively. Based on the intervention threshold (lumbar BMD T-score <  − 1.5), 15.1% of PCa patients required osteoporosis treatment; and, this value increased to 30.9% when L1–L4 CT-HU thresholds that corresponded to BMD T-score <  − 1.5 were used.

Conclusion

Lumbar BMD values from DXA may not reflect true bone health in PCa patients who often have lumbar degenerative diseases. Thresholds based on the vertebral CT-HU value can be used as a supplementary method to identify PCa patients who need anti-osteoporosis drugs.

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Acknowledgements

The authors wish to thank the investigators, their staff, and the affiliated institutions for their important contributions to this study at Toyonaka Municipal Hospital: Dr. Hiromu Horitani; Tetsuya Yamamoto; Yuta Oki.

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Authors and Affiliations

  1. Department of Urology, Toyonaka Municipal Hospital, Osaka, Japan

    Mototaka Sato, Atsuki Matsukawa, Ryoya Mizuno, Mai Akiyama, Norichika Ueda, Norihide Tei & Osamu Miyake

  2. Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibaharacho, Toyonaka, Osaka, 560-8565, Japan

    Masafumi Kashii, Takashi Kamatani & Hideki Yoshikawa

  3. Pharmaceuticals and Medical Devices Agency, Tokyo, Japan

    Satoshi Kamido

  4. Department of Urology, Suita Tokushukai Hospital, Osaka, Japan

    Jiro Nakayama

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  1. Mototaka Sato
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  2. Masafumi Kashii
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Contributions

M.S., M.K., S.K., H.Y. and O.M. contributed to conception and design of the study. M.S., M.K. and T.K. contributed to analysis and interpretation of data. M.S., A.M., R.M., M.A., N.U., J.N., N.T. and O.M. contributed to collection and assembly of data. M.S., M.K., N.U., H.Y. and O.M. contributed to drafting of the article. All the authors contributed to critical revision of the article for important intellectual content and final approval of the article.

Corresponding author

Correspondence to Masafumi Kashii.

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Conflict of interest

Mototaka Sato, Masafumi Kashii, Atsuki Matsukawa, Ryoya Mizuno, Mai Akiyama, Takashi Kamatani, Satoshi Kamido, Norichika Ueda, Jiro Nakayama, Norihide Tei, Hideki Yoshikawa and Osamu Miyake declare that they have no conflict of interest.

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Sato, M., Kashii, M., Matsukawa, A. et al. Assessment of bone health in patients with prostate cancer using cancer staging computed tomography. J Bone Miner Metab 40, 648–656 (2022). https://doi.org/10.1007/s00774-022-01328-4

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  • DOI: https://doi.org/10.1007/s00774-022-01328-4

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