Utilization of bone densitometry for prediction and administration of bisphosphonates to prevent osteoporosis in patients with prostate cancer without bone metastases receiving antiandrogen therapy

Abstract

BackgroundProstate cancer subjects with prostate-specific antigen (PSA) relapse who are treated with androgen deprivation therapy (ADT) are recommended to have baseline and serial bone densitometry and receive bisphosphonates. The purpose of this community population study was to assess the utilization of bone densitometry and bisphosphonate therapy in men receiving ADT for non-metastatic prostate cancer.MethodsA cohort study of men aged 65 years or older with non-metastatic incident diagnoses of prostate cancer was obtained from the Surveillance Epidemiology End Results (SEER)-linked Medicare claims between 2004 and 2008. Claims were used to assess prescribed treatment of ADT, bone densitometry, and bisphosphonates.ResultsA total of 30,846 incident prostate cancer cases receiving ADT and aged 65 years or older had no bone metastases; 87.3% (n=26,935) on ADT did not receive either bone densitometry or bisphosphonate therapy. Three percent (n=931) of the cases on ADT received bisphosphonate therapy without ever receiving bone densitometry, 8.8% (n=2,702) of the cases on ADT received bone densitometry without receiving intravenous bisphosphonates, while nearly 1% (0.90%, n=278) of the cases on ADT received both bone densitometry and bisphosphonates. Analysis showed treatment differed by patient characteristics.ConclusionContrary to the recommendations, bone densitometry and bisphosphonate therapy are underutilized in men receiving ADT for non-metastatic prostate cancer.

Changes in bone and mineral homeostasis after short-term androgen deprivation therapy with or without androgen receptor signalling inhibitor – substudy of a single-centre, double blind, randomised, placebo-controlled phase 2 trial

“…16 As a result, only a minority of patients receives adequate and timely treatment in case of poor bone health. 17 A major drawback of evaluating bone health in PCa patients with DXA is the fact that, due to the sensitivity, changes in bone mineral density (BMD) only occur as early as 6-12 months after initiation of ADT. 18,19 Consequently, the delay in changes in BMD may potentially result in a missed window of early treatment opportunity.…”

Opportunistic osteoporosis screening: contrast-enhanced dual-layer spectral CT provides accurate measurements of vertebral bone mineral density

“…For instance, men with prostate cancer receiving androgen deprivation therapy (ADT) bear an increased risk to suffer from accelerated bone loss, which is a major adverse effect [ 10 – 12 ]. Even though guidelines recommend evaluation with baseline and periodic follow-up BMD quantification [ 13 ], there is a severe under-use of dedicated imaging methods such as dual-energy x-ray absorptiometry (DXA) or quantitative CT (QCT)—e.g., for patients with non-metastatic prostate cancer, only about one in ten patients over 65 years receiving ADT undergoes a baseline bone densitometry [ 14 – 16 ].…”