- Design
- Systematic review and meta-analysis of cross-sectional and cohort studies
- Population
- 52 studies; 91,913 men with prostate cancer
- Primary outcome
- Prevalence of osteoporosis and low bone mass by BMD
- Effect
- Osteoporosis 22.0% (95% CI 19.9 to 24.1); low bone mass 41.7% (36.6 to 46.9); I² >95%
A systematic review and meta-analysis in Supportive Care in Cancer, published on 3 October, pooled 52 studies of 91,913 men with prostate cancer at any stage. Osteoporosis was defined mainly as a T-score of −2.5 or below, and low bone mass as between −2.5 and −1.0.
Pooled prevalence was 22.0% (95% CI 19.9 to 24.1) for osteoporosis and 41.7% (36.6 to 46.9) for low bone mass. Heterogeneity was extreme (I² above 95%), driven mostly by how bone density was measured and defined. The analysis did not show a link between duration of androgen deprivation therapy and prevalence, but duration data were missing in more than half of studies, so a real link cannot be ruled out.
The practical change is for the orthopaedic surgeon, not the oncologist. Men with fragility fractures are under-investigated compared with women, and androgen deprivation therapy is easy to miss in a history. When a man presents with a low-trauma fracture, a question about prostate cancer treatment identifies a group in whom bone density is often low and secondary prevention is easily overlooked.
The review measured prevalence only. It cannot show that screening or treatment reduces fractures, and it does not change existing guidance on bone protection with androgen deprivation therapy.
- Ask every man with a fragility fracture whether he has prostate cancer or has had androgen deprivation therapy.
- Consider bone density assessment and a fracture risk calculation for men on androgen deprivation therapy.
- Refer men with a fragility fracture to a fracture liaison or bone health service, as you would a woman.
- Check vitamin D and calcium intake in men on long-term hormone therapy.
- Communicate the fracture to the treating oncologist or urologist, who may not know of it.
Why it matters
Osteoporosis in men is under-recognised, and prostate cancer treatment is a common, often unasked cause.
Don't overread it
This measured prevalence only; it does not show that screening or bone treatment prevents fractures in these men.
The statistics, in plain English
An I² of 99% means the studies disagreed far more than chance would explain, so 22% is an average across very different populations rather than a precise rate. The narrow confidence interval reflects the size of the pooled data, not agreement between studies.
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