Abstract
Background
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.Objective
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.Methods
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 2 statistic. Subgroup, meta-regression, and sensitivity analyses were conducted to explore potential sources of heterogeneity.Results
Fifty-two studies comprising 91,913 men with PCa were included. All 52 studies contributed to the osteoporosis analysis (7,042 reported cases), and 42 studies contributed to the low bone mass analysis. The pooled prevalence of osteoporosis was 22.0% (95% CI: 19.9-24.1; I2 = 99.49%), and that of low bone mass was 41.7% (95% CI: 36.6-46.9; I2 = 95.85%). Pooled estimates varied across BMD ascertainment methods, outcome definitions, ADT categories, geographic regions, and study designs; the largest differences were methodological rather than clinical, and many subgroups contained only one or two studies, so these comparisons are exploratory. Meta-regression found no statistically significant links between publication year or ADT duration and overall prevalence. However, since ADT duration data were available for only 24 studies on osteoporosis and 20 on low bone mass, and residual heterogeneity remained above 92%, the lack of a detected association does not rule out a real connection. Sensitivity analyses yielded results similar to the main findings.Conclusions
Osteoporosis and low bone mass are frequently documented among men with PCa, although pooled estimates are limited by substantial heterogeneity across populations, densitometric methods, and diagnostic definitions. These data underscore the importance of considering bone health in PCa management protocols; however, this review assessed only prevalence and did not evaluate fracture incidence, screening effectiveness, or treatment efficacy. Consequently, it cannot confirm that any particular intervention diminishes fracture risk. There is a need for standardized longitudinal studies with harmonized BMD assessment.