Bone Health in Metastatic Hormone-Sensitive Prostate Cancer: Where We Stand and Where We Can Improve

Abstract

BACKGROUND: Androgen deprivation therapy (ADT) is a fundamental component of treatment for metastatic hormone-sensitive prostate cancer (mHSPC), but it accelerates bone mineral density loss and increases fracture risk. International guidelines recommend calcium and vitamin D supplementation, baseline dual-energy X-ray absorptiometry (DXA), and antiresorptive therapy in patients with osteoporosis. METHODS: We conducted a retrospective review of 156 mHSPC patients treated with ADT at a tertiary hospital between January 2022 and December 2024. We assessed adherence to guideline-recommended bone health measures. Collected variables included age, ADT duration, calcium/vitamin D supplementation, DXA testing, antiresorptive treatment, and fracture events. Exploratory stratified analyses were performed, and proportions were reported with 95% confidence intervals (CIs). RESULTS: Calcium/vitamin D supplementation was prescribed in 50.6% of patients (95% CI: 42.9-58.4), baseline DXA was performed in 12.8% (95% CI: 8.5-18.9), and denosumab was administered in 5.1% of the cohort (95% CI: 2.6-9.8). The median follow-up was 23 months, with a fracture incidence of 0.67 events per 100 person-years. Stratified analyses showed lower adherence in older patients, those with prolonged ADT exposure, and those with high metastatic burden. CONCLUSIONS: Adherence to guideline-recommended bone health measures in patients with mHSPC receiving ADT was markedly suboptimal. These findings underscore the need to implement standardized institutional protocols to ensure systematic supplementation, routine DXA monitoring, and appropriate antiresorptive therapy.