Osteoporosis and osteoporosis-related fractures among older male cancer patients: A nationwide study.

Abstract

11196 Background: Osteoporosis is commonly viewed as a disease of postmenopausal women, leading to significant underdiagnosis in men. Older male patients with cancer experience accelerated bone loss due to androgen deprivation therapy, corticosteroid exposure, and malignancy-related skeletal remodeling. We examined the prevalence, tumor-specific risk factors, and outcomes of osteoporosis and related fractures in a national cohort of older male cancer patients. Methods: We analyzed Nationwide Readmissions Database hospitalizations from 2019–2022, identifying male patients aged ≥60 years with malignancy. Primary outcomes were osteoporosis (ICD-10-CM M80/M81) and major osteoporotic fractures (hip, spine, humerus, wrist); isolated hip fracture was a secondary outcome. Survey-weighted multivariable logistic regression models identified independent predictors, adjusting for age, cancer type, metastatic status, and clinical risk factors. Results: Among an estimated 5.17 million weighted cancer admissions, 2.79 million occurred in males. Osteoporosis was diagnosed in 1.29% of males versus 7.16% of females ( P < 0.001); mean age at diagnosis was 76.5 vs 78.0 years. Men with osteoporosis had markedly higher fracture rates than those without, including hip fracture (5.11% vs 0.85%) and any major fracture (8.36% vs 1.60%) (all P < 0.001). In multivariable analysis, odds of osteoporosis diagnosis increased with age (OR 1.06 per year, P < 0.001). Diagnoses were most strongly associated with multiple myeloma (OR 1.63), prostate cancer (OR 1.33) (both P < 0.001), and leukemia (OR 1.16, P = 0.008). Hypogonadism (OR 4.77), hyperparathyroidism (OR 3.53), vitamin D deficiency (OR 2.51), and tobacco use (OR 1.08; P = 0.009) were independent clinical predictors. In fracture models, prior osteoporosis diagnosis was the strongest predictor of any major fracture (OR 4.11) and hip fracture (OR 2.41) (both P < 0.001). Modifiable risks, including tobacco use (OR 1.55–1.61) and vitamin D deficiency (OR 1.68–1.88) (both P < 0.001), consistently increased fracture risk. Prostate cancer increased odds of both major (OR 1.11) and hip fractures (OR 1.21) ( P < 0.001), whereas multiple myeloma increased odds of major fracture (OR 1.19, P = 0.004) but was associated with lower odds of hip fracture (OR 0.80, P = 0.03). Conclusions: Older men with cancer face substantial, under-recognized risk for osteoporosis and fracture-related morbidity. Tumor-specific patterns and modifiable clinical factors identify clear opportunities for earlier risk assessment and integration of bone health strategies into routine oncologic care.