title: Lateral spine radiographs before androgen deprivation treatment detect a high incidence of undiagnosed vertebral fragility fractures in men with advanced prostate cancer.
abstract: OBJECTIVE
  Baseline bone mineral density scanning in patients about to commence long-term androgen deprivation therapy for advanced/metastatic prostate cancer is reported to show a high incidence of osteoporosis and osteopenia. We investigated the incidence of existing spinal osteoporotic fractures in this population as this is known to be a risk factor for the development of treatment induced fractures.
  
  
  METHODS
  Since 2003 we performed lateral thoracolumbar x-rays on all patients before androgen deprivation therapy for prostate cancer. The heights of T4-L5 vertebral bodies were measured, then reanalyzed by the Eastell method to define grade 1 or worse grade 2 vertebral crush fractures. We used a morphometric algorithm including an age stratified random sample of men with normal thoracolumbar x-rays to quantitatively assess fractures.
  
  
  RESULTS
  A total of 202 patients with prostate cancer underwent thoracolumbar x-rays before androgen deprivation therapy. Of the patients 61.9% had 1 or more grade 1 and 60.9% had 1 or more grade 2 wedge fractures. In addition, 46.5% of patients had 1 or more grade 1 and 44.6% had greater than 1 grade 2 biconcavity fractures. Finally 63.9% of patients had 1 or more grade 1 and 47.8% had 1 or more grade 2 compression fractures. With conventional reporting 72.4% of patients had no bony abnormality, 14.9% had 1 and 12.7% multiple vertebral crush fractures. Bone mineral density was significantly less in patients with fracture(s) vs those with no abnormality (p<0.001).
  
  
  CONCLUSIONS
  Routine reporting identifies a high incidence of spinal fractures before commencing androgen deprivation therapy, but this is much greater when quantitative assessment is applied. Thoracolumbar x-rays identify the risk of treatment induced fracture and allow baseline comparison in individuals who experience back pain on androgen deprivation therapy. We advocate more routine adoption of baseline thoracolumbar x-rays in patients with prostate cancer.
authors.affiliation: Department of Urology, Wirral University Teaching Hospital, Wirral, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: Mistry
authors.forename: D
authors.initials: D
authors.lastname: Hughes
authors.forename: V
authors.initials: V
authors.lastname: Wadhwa
authors.forename: N
authors.initials: N
authors.lastname: Parr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use; D015519:Bone Density; D006801:Humans; D015994:Incidence; D008297:Male; D009367:Neoplasm Staging; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology; D011471:Prostatic Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D011859:Radiography; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology
chemical_list: D000726:Androgen Antagonists