Background
The use of androgen deprivation therapy (ADT) for prostate cancer has increased substantially in recent years, exposing more
men to potential treatment complications, including osteoporosis and fractures.
Objective
To determine whether men treated with ADT for prostate cancer received osteoporosis screening, prevention, or treatment.
Design
Cross-sectional observational study using a retrospective review of electronic medical records.
Subjects
One hundred seventy-four patients with prostate cancer on ADT or status-post orchiectomy enrolled in primary care at the New
Mexico Veterans Affairs Health Care System as of July 2005.
Measurements
Patient demographics, tumor characteristics (Gleason score, stage, last PSA value, documented bone metastases), history of
hip or vertebral fracture, osteoporosis risk factors (number of ADT shots, diabetes, smoking, heavy alcohol use or prescriptions
for corticosteroids, thyroid hormone or dilantin). We defined recommended management as performing DXA scans or prescribing
bisphosphonates, calcitonin, calcium or vitamin D.
Results
Just 60 of 174 (34%) patients received recommended osteoporosis management based on DXA scans (13%) or treatment with oral
or IV bisphosphonates (21%), calcitonin (1%), calcium (16%) or vitamin D (10%). On multivariate analysis, bone metastases,
higher last PSA, and younger age at diagnosis were associated with recommended management, whereas Hispanic race/ethnicity
was inversely associated.
Conclusions
Most men treated with ADT for prostate cancer did not receive osteoporosis screening, prevention or treatment. Evidence for
advanced cancer though not risk factors for osteoporosis or fracture—was associated with receiving osteoporosis management.
Further research is needed to identify optimal strategies for screening, prevention, and treatment in this population.
KEY WORDS osteoporosis - prostate cancer - androgen deprivation therapy - screening - prevention - DXA scan