Alteration of bone architecture following androgen deprivation therapy in patients with prostate cancer using 3D-modeling from hip DXA

Androgen deprivation therapy (ADT) for prostate cancer negatively affect areal bone mineral density (aBMD); however, its impact on volumetric BMD (vBMD) and bone geometry remains underexplored. This study aimed to evaluate changes in aBMD, vBMD, and hip structural analysis (HSA) following one year of ADT.

This retrospective observational study included 41 patients with prostate cancer without bone metastasis who received ADT for one year and underwent dual-energy X-ray absorptiometry (DXA) both before and after treatment. In addition to aBMD, trabecular and cortical vBMD, integral vBMD (trabecular + cortical), cortical surface BMD (sBMD), cortical thickness, and hip structural parameters were assessed at the hip using 3D-Shaper software.

The mean age and body mass index of the patients were 75.5 ± 6.8 years and 24.0 ± 3.0 kg/m², respectively. More than half had a Gleason score of 4 or 5, and the majority had T3 disease. After one year of ADT, significant reductions in aBMD were observed at the lumbar spine (-4.5 ± 4.0 %, P < 0.001) and total hip (-3.7 ± 5.1 %, P < 0.001). 3D-DXA analysis revealed significant declines in integral vBMD (-3.8 ± 3.9 %) and trabecular vBMD (-4.9 ± 7.4 %) (both P < 0.001), while cortical vBMD showed no significant change (-1.6 ± 6.0 %, P = 0.062) at the total hip. Cortical sBMD decreased significantly by -2.7 ± 5.2 % (P < 0.001). Cortical thickness also significantly decreased at the total hip (-1.2 ± 3.2 %, P = 0.011). With respect to hip structural parameters, cross-sectional area consistently decreased, and buckling ratio increased across the femoral neck, trochanteric, and shaft regions (all P < 0.05), indicating increased femoral fragility and reduced resistance to axial and compressive forces.

ADT exerts a substantial detrimental effect on bone strength, resulting in reductions in aBMD, vBMD, and alteration of HSA. 3D-DXA may serve as a valuable and accessible tool for detecting structural bone changes in prostate cancer patients undergoing ADT.