Prevalence of fractures among men with stage IV prostate cancer (S4PC).

Abstract

143 Background: Fractures (fx) are common in men with stage 4 prostate cancer (S4PC), resulting in significant clinical consequences, such as increased pain and decreased quality of life. The aim of this study was to estimate the prevalence of fx among men diagnosed with non-metastatic (M0) or metastatic (M1) S4PC and evaluate risk factors associated with fx. Methods: We estimated the prevalence of fx among men age 66 or older diagnosed with M0 or M1 S4PC using data from the U.S. SEER-Medicare datasets between 2000 to 2007. Men were followed through December 2009 or until they were lost to follow up. Codes indicating “pathologic fracture” or “fracture,” excluding codes suggesting accidents/falls in the 14 days prior to the fx, were used to identify fx. Results: Among 9,826 men with S4PC (M1 = 7301; M0 = 2525), 12.9% experienced a post-diagnosis fx based on the codes used. The prevalence of fx was nearly twice as high in men with M1 versus M0 S4PC (M1 = 14.7%; M0 = 7.5%). The median time from diagnosis of S4PC to first fx was five months for men with M1 S4PC versus 34 months for men with M0 S4PC. Compared to men with no fx, men who experienced fx were more likely to be older (20.3% vs. 17.8%), of white/non-Hispanic race (81.1% vs. 75.3%), have well (cancer grade 1) or moderately (cancer grade 2) differentiated tumors (48.7% vs. 41.7%), have a claim of osteoporosis (2.4% vs. 0.6%) or osteoarthritis (9.3% vs. 6.5%) in the year prior to S4PC diagnosis, and to have taken a bone mineral density (BMD) test (13.5% vs. 8.1%). All differences were significant at p<0.05 level. Overall, 92% of men did not receive BMD testing at any time post diagnosis despite the fact that 67% of the men received ADT. Conclusions: In men with M1 S4PC at diagnosis, the prevalence of fx is higher and the time to fx is substantially shorter than in men with M0 S4PC at diagnosis. Furthermore, most men with S4PC do not receive BMD testing. A significant need remains to monitor bone health and treat fx, particularly among M1 S4PC patients.

Prevalence and risk of skeletal complications and use of radiation therapy in elderly women diagnosed with metastatic breast cancer

“…Despite such differences, AA women had significantly less fractures (p<0.01); such racial differences in fracture risk are also observed among men with metastatic prostate cancer. [ 22 ] Thus, AA patients with advanced hormonally driven cancers (such as breast and prostate cancers) are less likely to experience fractures across both genders, perhaps in part reflecting the known differences in bone mineral density between the AA and NHW racial groups. [ 23 ] Interventions (radiation, bone surgery) were also significantly less likely in AA women ( Table 3 ); the lower likelihood for such interventions may partly be due to the lower occurrence of fractures among the AA patients.…”