A report published by Hu et al in JNCCN—Journal of the National Comprehensive Cancer Network found the rate of bone mineral density testing in people with prostate cancer undergoing androgen-deprivation therapy (ADT) has improved in recent years, but remains low.
ADT is considered a cornerstone of treatment for high-risk or advanced prostate cancer and is used in nearly half of all patients with prostate cancer. However, it can result in preventable side effects like osteoporosis and bone fractures. Despite clinical recommendations that call for bone mineral density testing in ADT recipients, only 23.4% of the patients studied received testing in 2015. That is up from just 4.1% in 2000.
“Although we expected bone mineral density testing rates to be fairly low given the prior literature, we were somewhat surprised that they didn’t go up more in recent years,” said senior author Alice Dragomir, MSc, PhD, of McGill University in Montreal. “Bone density testing helps doctors evaluate fracture risk and identify which patients would benefit from additional monitoring and interventions like lifestyle changes and/or medications. 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. It may be interesting to re-examine bone mineral density testing rates in a few years.”
Study Findings
KEY POINTS
- 17.8% of the patient population received a bone mineral density test at any point during the study period.
- The largest increase in testing rates occurred around 2003 and 2004, coinciding with the publication of several articles and guidelines recommending bone mineral density screening in this set of patients.
- People aged 80 and older, with metastatic disease, or living in rural areas were less likely to be screened for bone mineral density.
The researchers used the Régie de l’assurance maladie du Québec (RAMQ)—a Canadian public health-care administrative database—to review patient demographic and billing information for 22,033 people with prostate cancer who began receiving ADT between January 2000 and December 2015. Of those, 3,910 (17.8%) received a bone mineral density test at any point during the study period. The largest increase in testing rates occurred around 2003 and 2004, coinciding with the publication of several articles and guidelines recommending bone mineral density screening in this set of patients. People aged 80 and older, with metastatic disease, or living in rural areas were less likely to be screened for bone mineral density.
“While we have known for many years that the androgen-deprivation therapies used to treat prostate cancer carry an increased risk of osteoporosis, this study identifies specific populations that might not undergo recommended screening prior to hormone-based therapies,” commented Joshua M. Lang, MD, MS, Associate Professor of Medicine, Carbone Cancer Center, University of Wisconsin. “These populations are especially vulnerable, including our older patients located in rural areas of the country.”
Dr. Lang, a Member of the NCCN Guidelines® Panel for Prostate Cancer, who was not involved in this research, continued, “The importance of screening is even more critical given the availability of medications that can slow or reverse osteoporosis. The NCCN Guidelines for Prostate Cancer specifically recommend screening for these patients, and this report demonstrates that more work is needed to advocate for and implement screening of vulnerable patient populations.”
Disclosure: For full disclosures of the study authors, visit jnccn.org.
