Prevalence of osteoporosis and low bone mass in men with prostate cancer: a systematic review and meta-analysis

Prostate cancer (PCa) and its treatments, notably androgen-deprivation therapy (ADT), are linked to accelerated bone loss, thereby elevating the risk of osteoporosis and fractures. Nevertheless, comprehensive data on the prevalence of osteoporosis and low bone mass (osteopenia) in men with PCa are still limited.

To systematically review and meta-analyze the prevalence of osteoporosis and low bone mass in adult men with PCa at all disease stages, and to investigate study-level factors such as ADT category and duration that might influence these estimates.

We conducted a systematic search of PubMed, Scopus, Web of Science, Embase, CINAHL, and ProQuest for studies published between January 1994 and October 2025. Population- or institution-based cross-sectional and cohort studies reporting the prevalence of osteoporosis or low bone mass among adult PCa patients were included. Osteoporosis and low bone mass were classified primarily according to BMD T-score thresholds of ≤  - 2.5 and >  - 2.5 to <  - 1.0, respectively, while study-specific definitions and ascertainment methods were recorded and considered in subgroup analyses. Risk-of-bias assessment was independently performed using the Joanna Briggs Institute checklist. Pooled prevalence estimates were calculated using random-effects meta-analysis, and heterogeneity was assessed using the I2 statistic. Subgroup, meta-regression, and sensitivity analyses were conducted to explore potential sources of heterogeneity.