The implications of baseline bone‐health assessment at initiation of androgen‐deprivation therapy for prostate cancer

Peter S. Kirk, Tudor Borza, Vahakn B. Shahinian, Megan E.V. Caram, Danil V. Makarov, Jeremy B. Shelton, John T. Leppert, Ryan M. Blake, Jennifer A. Davis, Brent K. Hollenbeck, Anne Sales, Ted A. Skolarus

To assess bone density testing (BDT) use among prostate cancer survivors receiving ADT, and downstream implications for osteoporosis and fracture diagnoses as well as pharmacologic osteoporosis treatment in a national integrated delivery system. We identified 17,017 men with prostate cancer who received any ADT between 2005 and 2014 using Veterans Health Administration cancer registry and administrative data. We identified claims for BDT within a 3-year period of ADT initiation. We then used multivariable regression to examine the association between BDT use and incident osteoporosis, fracture, and use of pharmacologic treatment. We found a minority of patients received BDT (n=2,502, 15%), however the rate of testing increased to over 20% by the end of the study period. Men receiving BDT were older at diagnosis and had higher-risk prostate cancer (both p<0.001). Osteoporosis and fracture diagnoses, use of vitamin D ± calcium, and bisphosphonates were all more common in men who received BDT. After adjustment, BDT, and to a lesser degree, 2 or more years of ADT, were both independently associated with incident osteoporosis, fracture, and osteoporosis treatment. Bone density testing is rare among prostate cancer patients treated with ADT in this integrated delivery system. However, BDT was associated with substantially increased treatment of osteoporosis indicating an underappreciated burden of osteoporosis among prostate cancer survivors initiating ADT. Optimizing BDT use and osteoporosis management in this at-risk population appears warranted. This article is protected by copyright. All rights reserved.