Sarcopenia, the age associated loss of skeletal muscle mass and function, has considerable societal consequences for the development of frailty, disability and health care planning. A group of geriatricians and scientists from academia and industry met in Rome, Italy on November 18, 2009 to arrive at a consensus definition of sarcopenia. The current consensus definition was approved unanimously by the meeting participants and is as follows: Sarcopenia is defined as the age-associated loss of skeletal muscle mass and function. The causes of sarcopenia are multi-factorial and can include disuse, altered endocrine function, chronic diseases, inflammation, insulin resistance, and nutritional deficiencies. While cachexia may be a component of sarcopenia, the two conditions are not the same. The diagnosis of sarcopenia should be considered in all older patients who present with observed declines in physical function, strength, or overall health. Sarcopenia should specifically be considered in patients who are bedridden, cannot independently rise from a chair, or who have a measured gait speed less that 1.0 m·s−1. Patients who meet these criteria should further undergo body composition assessment using dual energy x-ray absorptiometry (DXA) with sarcopenia being defined using currently validated definitions. A diagnosis of sarcopenia is consistent with a gait speed of less than 1 m·s−1 and an objectively measured low muscle mass (eg: appendicular mass relative to ht2 that is ≤ 7.23 kg/ m2 in men ≤ 5.67 kg/ m2 in men). Sarcopenia is a highly prevalent condition in older persons that leads to disability, hospitalization and death.

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BackgroundAndrogen deprivation therapy (ADT) in prostate cancer (PCa) is associated with an increased risk of bone fragility including bone loss, osteoporosis and fractures. Although international recommendations suggest performing dual-energy x-ray absorptiometry (DXA) at the initiation of treatment, less than 10% of patients do it. The implementation of a standardised clinical care pathway could help prevent bone-related complications in patients starting ADT.ObjectivesTo improve screening for bone fragility in patients starting ADT for PCa by setting up a clinical care pathway. To describe the characteristic of patients with PCa starting ADT.MethodsThe radiation oncologists, medical oncologists or urologists from a tertiary center systematically referred all patients starting any ADT for PCa to our rheumatology department for a bone-health assessment including a DXA and clinics with a bone specialist. The effectiveness of the pathway was assessed by the number of patients who performed DXA at the initiation of ADT.ResultsBetween March and December 2022, 116 of the 119 patients (97%) referred to our department were able to have a bone assessment within an average of 36 +/- 15 days. The three patients not seen in the care pathway did not wish to come for a new medical appointment.Among the 116 patients, mean age at first visit was 75+/-7 years old, mean BMI 26.9 +/- 4.7 kg/m2, 56% were previous or current smoker and Charlson Comorbidity Index was 4.75 +/- 2.5 with 20% diabetes, 15% peripheral vascular disease, 11% coronaropathy and 10% chronic kidney disease.Regarding PCa, 65% were on a localized or locally-advanced stage while 35% were metastatic and overall, 44% presented with a high risk histo-pronostic score (ISUP 4 or 5). Sixty-four patients (55%) were scheduled to concomitant prostatic external beam radiation, as initial or salvage therapy. Median PSA at diagnosis was 16 ng/ml (8.8-38.5) At inclusion, 70% of patients were newly-diagnosed PCa while 30% were recurrent PCa. ADT was prescribed alone for 65% of patients or in combination with new hormone-therapy (NHT) for 35% of patients and 26% with concomitant corticosteroids with a mean dose of 10 +/-4 mg. The mean duration of previous ADT for relapsing patients was 16 +/- 20 months.Regarding bone disease, 11% patients had previous bone fracture mainly in the spine, 15% had familial history of hip fracture and 20% reported a fall within the past year. Forty-two percent of patients had vitamin D supplementation but only one was previously treated with an anti-osteoporotic agent. Finally, 114 patients had a DXA. A lumbar BMD T-score ≤-2.5 was found for 9 patients, ≤ -2 for 17 patients. A hip BMD T-score ≤ -2.5 was found for 12 patients and ≤ -2 for 35 patients. A T-score ≤ -2.5 to at least one site was found in 18 patients (16%) and ≤ -2 for 41 patients (35%). After BMD assessment, an anti-osteoporotic treatment was prescribed in 40% of patients with bisphosphonate (71%) or denosumab (29%).ConclusionThis clinical care pathway allowed 97% of patients to have a bone assessment when starting ADT for PCa. This cohort of 116 patients confirms the high prevalence of low BMD among these patients and the need to screen and treat patients to prevent bone-related complications.AcknowledgementsI thanks Mioranirainy DERAHARIJAONA and Catherine LE BOURLOUT for their help in collecting clinical data.Disclosure of InterestsNone Declared.