Rates of BMD Testing After ADT in Prostate Cancer Patients Remain Low

October 14, 2020

An analysis of 22k prostate cancer patients over a 15-year period suggests less than 1-in-4 undergo bone mineral density testing after androgen deprivation therapy.

Despite increased emphasis in guidelines and recommendations, new research suggests rates of bone mineral density (BMD) testing remain low among patients with a history of androgen deprivation therapy for prostate cancer, which investigators suggest could be cause for concern.

An analysis of data from Régie de l'assurance maladie du Québec (RAMQ) database, results of indicate less than 1-in-4 patients who received androgen deprivation therapy for prostate cancer during the 15-year study underwent BMD testing.

"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," said lead investigator Alice Dragomir, MSc, PhD, of McGill University in Quebec, in a statement."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 BMD testing rates in a few years."

Together with a team of colleagues from McGill University, Dragomir hoped to detail the current rates of BMD testing among prostate cancer patients treated with androgen deprivation therapy, which investigators noted encompasses nearly half of all patients with prostate cancer. Using the RAMQ database, investigators identified a cohort of 37,475 patients with prostate cancer treated with androgen deprivation therapy between January 2000 and December 2015.

The primary outcome of the analysis was the receipt of a BMD test during the 18-month period that began 6 months prior to initiation of androgen deprivation therapy and up to 12 months after. For the purpose of the analysis, investigators defined the baseline BMD period as the period beginning 6 months prior to androgen deprivation therapy until 3 months following.

Of the 37,475 originally identified by investigators, 22,033 were included in the final analysis. Patients were excluded if they had no continuous long-term androgen deprivation therapy use for at least 12 months or if they initiated continuous long-term androgen deprivation therapy before 2000.

Of the 22,033 included in the study, 17.8% (n=3910) had undergone a BMD test at some point during the study period. Investigators pointed out the results reflected an increase in BMD testing during the study period, with rates increasing from 4.1% in 2000 to 23.4% in 2015 (P <.001).

When assessing factors associated with lower odds of undergoing a BMD test, results suggested patients who were 80 years of age or older (OR, 0.67; 95% CI, 0.59-0.76; P <.001), those with metastatic disease (OR, 0.79; 95% CI, 0.70-0.89; P <.001) , or those living in rural areas were less likely to be screened (OR, 0.77; 95% CI, 0.68-0.87; P <.001). Factors associated with greater odds of BMD testing included history of osteoporosis(OR, 1.84; 95% CI, 1.32-2.57; P <.001), rheumatoid arthritis (OR, 1.64; 95% CI, 1.15-2.34; P=.006), and long-term corticosteroid use (OR, 1.63; 95% CI, 1.15-2.31; P=.006).

In the aforementioned statement, Joshua Lang, MD, MS, who was not an investigator in the study but is a member of the National Comprehensive Cancer Network Guidelines Panel for Prostate Cancer, noted the importance of recommended screenings and addressing the increased risk of osteoporosis in this specific patient population.

"The importance of screening is even more critical given the availability of medications that can slow or reverse osteoporosis,” Lang said. “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."

This study, “Contemporary Population-Based Analysis of Bone Mineral Density Testing in Men Initiating Androgen Deprivation Therapy for Prostate Cancer,” was published in the Journal of the National Comprehensive Cancer Network.