In a nutshell
This study evaluated the bone mineral density (BMD) screening rates and their association with fracture rates among older men with prostate cancer (PC) receiving androgen deprivation therapy (ADT). The data showed that BMD screening is associated with a lower major fracture risk in these patients.
Prostate cancer (PC) often grows in response to androgens (male sex hormones such as testosterone). These patients are usually treated with androgen deprivation therapy (ADT). ADT reduces the production of androgens. Reducing these androgens prevents cancer cell growth.
ADT is associated with a decrease in bone mineral density (BMD) or a loss of bone mass. BMD is a measurement of bone density and strength and refers to the amount of minerals (such as calcium) in the bones. Low BMD is associated with osteoporosis that can lead to a high risk of fractures (breaking of the bone). Bone health screening is recommended in the US for patients with PC who are starting treatment with ADT. Currently, dual-energy X-ray absorptiometry (DXA) is the standard for BMD assessment/ DXA is low-cost, has low radiation exposure, and ability to monitor treatment response. However, little is known about the DXA screening rates and their association with fracture rates among older men with PC starting treatment with ADT.
Methods & findings
This study involved 54,953 men with PC who started treatment with ADT. between 2005 and 2015 Only 4362 (7.9%) men received DXA screening. The DXA screening rate increased from 6.8% in 2005 to 8.4% in 2015.
Non-Hispanic Black men were 20% less likely to receive DXA screening. Patients who were single were 11% less likely to receive DXA screening. Patients living in living in small urban areas were 23% less likely, patients living in areas with lower educational levels were 25% less likely, and patients receiving nonsteroidal androgens were 43% less likely to receive DXA screening.
After initial receipt of ADT, 17.5% developed fractures at any site and 7.7% developed major fractures (such as spine, arm, or hip). The average time to first fracture was 31 months. After 5 years, 84% of the patients were alive without developing any fractures and 89% were alive without developing major fractures.
Overall, previous DXA screening was associated with a 9.1% decrease in the risk of major fractures.
The bottom line
This study concluded that DXA screening is important for the prevention of major fractures among older men with PC receiving treatment with ADT.
The fine print
This study looked back in time at medical records. This study only included patients who were older than 65 years old and mostly with localized disease. The results cannot be generalized to younger patients. Also, there was no analysis of the risk of fractures in men who had DXA screening and received treatment with bone-modifying agents.
Published By :
JAMA network open
Apr 01, 2022
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