Men with prostate cancer: one in five has osteoporosis, so ask about androgen deprivation

The edition in brief

Today's orthopaedics edition ends on bone health in men with prostate cancer. A meta-analysis of 52 studies and 91,913 men found pooled osteoporosis prevalence of 22.0% and low bone mass of 41.7%, with very high heterogeneity; it measured prevalence, not fractures or treatment effect. For the surgeon seeing a man with a fragility fracture, a history of androgen deprivation therapy is a reason to assess bone health. An external validation of the American College of Radiology's Bone-RADS score in 423 adult long-bone lytic lesions found sensitivity 97.1% and specificity 67.4% for malignancy, with moderate agreement between readers on the four-tier score; it works as a triage tool rather than a diagnosis. A randomised trial of 58 patients having single-level full-endoscopic lumbar discectomy found that prophylactic intravenous tranexamic acid did not improve surgeon-rated or video-measured visualisation. A small randomised trial of 20 patients with transverse metacarpal shaft fractures found a single buried intramedullary K-wire without splinting gave better motion and DASH scores at 4 weeks than transverse wiring with a splint, with no difference by 12 weeks. The pearl is staging a lytic lesion before biopsy.