Osteoporosis Management in Prostate Cancer Patients Treated with Androgen Deprivation Therapy

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.

To determine whether men treated with ADT for prostate cancer received osteoporosis screening, prevention, or treatment, researchers at Albuquerque designed a cross-sectional observational study using a retrospective review of electronic medical records. The subjects were 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. Patient demographics, tumour 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) were measured. The researchers defined recommended management as performing DXA scans or prescribing bisphosphonates, calcitonin, calcium or vitamin D. 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. The study concluded that 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. The study recommends that further research is needed to identify optimal strategies for screening, prevention, and treatment in this population.(Source: Yee EF, White RE, Murata GH, Handanos C, Hoffman RM. Osteoporosis management in prostate cancer patients treated with androgen deprivation therapy. J Gen Intern Med. 2007 Sep;22(9):1305-10. Epub 2007 Jul 17. : August 2007)