Bone mineral density testing rates still low among men receiving ADT for prostate cancer
Rates of bone mineral density testing among men with prostate cancer undergoing androgen deprivation therapy have risen since 2000 but remain low, according to study results published in Journal of the National Comprehensive Cancer Network.
Men who are older, those with metastatic disease and residents of rural areas appeared less likely to receive testing, researchers found. They noted that further efforts may be needed to emphasize the importance of bone mineral density (BMD) testing in prostate cancer guidelines.
“Although we expected BMD testing rates to be fairly low given the prior literature, we were somewhat surprised that they didn’t go up more in recent years,” Alice Dragomir, MSc, PhD, associate professor in the department of surgery at McGill University in Canada, said in a press release. “Bone density testing helps doctors evaluate fracture risk and identify which patients would benefit from additional monitoring and interventions like lifestyle change or medications.”
ADT is a cornerstone of treatment for advanced prostate cancer; however, it accelerates the loss of BMD, according to study background. This leads to increased risk for osteoporosis and fracture.
Guidelines recommend BMD testing when starting ADT to assess baseline fracture risk.
Dragomir and colleagues examined the proportion of BMD testing and factors associated with its use among 22,033 men who received ADT in Quebec between 2000 and 2015 for longer than 12 months.
Among these men, 3,910 (17.8%) underwent BMD testing.
Receipt of BMD testing from 6 months before to 12 months after ADT initiation served as the study’s primary outcome.
Results showed rates of BMD testing increased from 4.1% in 2000 to 23.4% in 2015.
Factors associated with higher odds of BMD testing included a history of osteoporosis (OR = 1.84; 95% CI, 1.32-2.57), rheumatoid arthritis (OR = 1.64; 95% CI, 1.15-2.34), use of bisphosphonates (OR = 1.47; 95% CI, 1.25-1.73) and long-term corticosteroid use (OR = 1.63; 95% CI, 1.15-2.31).
Factors associated with lower odds of BMD testing included being aged 80 years or older (OR = 0.67; 95% CI, 0.59-0.76), metastatic disease (OR = 0.79; 95% CI, 0.7-0.89), having a Charlson comorbidity score of 4 or higher (OR = 0.65; 95% CI, 0.51-0.81) and living in a rural area (OR = 0.77; 95% CI, 0.68-0.87).
“[Although] we have known for many years that the [ADTs] used to treat prostate cancer carry an increased risk for osteoporosis, this study identifies specific populations that might not undergo recommended screening prior to hormone-based therapies,” Joshua M. Lang, MD, MS, associate professor in the department of medicine at University of Wisconsin School of Medicine and Public Health, said in the press release. “These populations are especially vulnerable, including our older patients located in rural areas of the country.”
Lang, who serves on the National Comprehensive Cancer Network guidelines panel for prostate cancer and was not involved in the study, said the NCCN guidelines recommend screening for these men. He added that more work is required to ensure vulnerable populations receive screening.
“Perhaps the low rate of testing will change in the coming years, thanks to renewed attention on bone health issues in the clinical oncology community,” Dragomir said. “It may be interesting to reexamine BMD testing rates in a few years.”