Patterns of Bone Mineral Density Testing in Men Receiving Androgen Deprivation for Prostate Cancer
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Practice guidelines recommend bone mineral density (BMD) monitoring for men on androgen deprivation therapy (ADT) for prostate cancer, but single center studies suggest this is underutilized.
We examined determinants of BMD testing in men receiving ADT in a large population-based cohort of men with prostate cancer.
Retrospective cohort study.
We used the Surveillance, Epidemiology and End-Results (SEER)-Medicare database to identify 84,036 men with prostate cancer initiating ADT from 1996 through 2008.
Rates of BMD testing within the period 12 months prior to 3 months after initiation of ADT were assessed and compared to matched controls without cancer and to men with prostate cancer not receiving ADT. A logistic regression model was performed predicting use of BMD testing, adjusted for patient demographics, indications for ADT use, year of diagnosis and specialty of the physician involved in the care of the patient.
Rates of BMD testing increased steadily over time in men receiving ADT, diverging from the control groups such that by 2008, 11.5 % of men were receiving BMD testing versus 4.4 % in men with prostate cancer not on ADT and 3.8 % in the non-cancer controls. In the logistic regression model, year of diagnosis, race/ethnicity, indications for ADT use and geographic region were significant predictors of BMD testing. Patients with only a urologist involved in their care were significantly less likely to receive BMD testing as compared to those with both a urologist and a primary care physician (PCP) (odds ratio 0.71, 95 % confidence interval 0.64–0.80).
There has been a sharp increase in rates of BMD testing among men receiving ADT for prostate cancer over time, beyond rates noted in contemporaneous controls. Absolute rates of BMD testing remain low, however, but are higher in men who have a PCP involved in their care.
- Shahinian, VB, Kuo, YF, Gilbert, SM (2010) Reimbursement policy and androgen-deprivation therapy for prostate cancer. N Engl J Med 363: pp. 1822-1832 CrossRef
- Crawford, ED, Eisenberger, MA, McLeod, DG, Spaulding, JT, Benson, R, Dorr, FA (1989) A controlled trial of leuprolide with and without flutamide in prostatic carcinoma. N Engl J Med 321: pp. 419-24 CrossRef
- D’Amico, AV, Manola, J, Loffredo, M, Renshaw, AA, DellaCroce, A, Kantoff, PW (2004) 6-month androgen suppression plus radiation therapy vs radiation therapy alone for patients with clinically localized prostate cancer: a randomized controlled trial. JAMA 292: pp. 821-827 CrossRef
- Bolla, M, Reijke, TM, Tienhoven, G, Bergh, AC, Oddens, J, Poortmans, PM (2009) Duration of androgen suppression in the treatment of prostate cancer. N Engl J Med 360: pp. 2516-2527 CrossRef
- Daniell, HW, Dunn, SR, Ferguson, DW (2000) Progressive osteoporosis during androgen deprivation therapy for prostate cancer. J Urol 163: pp. 181 CrossRef
- Wei, JT, Gross, M, Jaffe, CA (1999) Androgen deprivation therapy for prostate cancer results in significant loss of bone density. Urology 54: pp. 607 CrossRef
- Diamond, T, Campbell, J, Bryant, C (1998) The effect of combined androgen blockade on bone turnover and bone mineral densities in men treated for prostate carcinoma. Cancer 83: pp. 1561 CrossRef
- Smith, M, McGovern, FJ, Zietman, AL (2001) Pamidronate to prevent bone loss during androgen-deprivation therapy for prostate cancer. N Engl J Med 345: pp. 948 CrossRef
- Ross, RW, Small, EJ (2002) Osteoporosis in men treated with androgen deprivation therapy for prostate cancer. J Urol 167: pp. 1952-1956 CrossRef
- Smith, MR (2002) Osteoporosis during androgen deprivation therapy for prostate cancer. Urology 60: pp. 79-85 CrossRef
- Berruti, A, Tucci, M, Terrone, C, Gorzegno, G, Scarpa, RM, Angeli, A (2002) Background to and management of treatment-related bone loss in prostate cancer. Drugs Aging 19: pp. 899-910 CrossRef
- Scardino, P (2005) Update: NCCN prostate cancer clinical practice guidelines. J Natl Compr Canc Netw 3: pp. S29-33
- Shahinian, VB, Kuo, YF, Freeman, JL, Goodwin, JS (2005) Risk of fracture after androgen deprivation for prostate cancer. N Engl J Med 352: pp. 154-164 CrossRef
- Smith, MR, Lee, WC, Brandman, J, Wang, Q, Botteman, M, Pashos, CL (2005) Gonadotropin-releasing hormone agonists and fracture risk: a claims-based cohort study of men with nonmetastatic prostate cancer. J Clin Oncol 23: pp. 7897-7903 CrossRef
- http://www.nccn.org. NCCN clinical practice guidelines in oncology version 1.2013 prostate cancer. Last accessed March 4th, 2013.
- Tanvetyanon, T (2005) Physician practices of bone density testing and drug prescribing to prevent or treat osteoporosis during androgen deprivation therapy. Cancer 103: pp. 237-241 CrossRef
- Wilcox, A, Carnes, ML, Moon, TD, Tobias, R, Baade, H, Stamos, E, Elliott, ME (2006) Androgen deprivation in veterans with prostate cancer: implications for skeletal health. Ann Pharmacother 40: pp. 2107-2114 CrossRef
- Yee, EFT, White, RE, Murata, GH, Handanos, C, Hoffman, RM (2007) Osteoporosis management in prostate cancer patients treated with androgen deprivation therapy. J Gen Int Med 22: pp. 1305-1310 CrossRef
- Alibhai, SMH, Yun, L, Cheung, AM, Paszat, L (2012) Screening for osteoporosis in men receiving androgen deprivation therapy. JAMA 307: pp. 255-256 CrossRef
- Warren, JL, Klabunde, CN, Schrag, D, Bach, PB, Riley, GF (2002) Overview of the SEER-medicare data: content, research applications, and generalizability to the United States elderly population. Med Care 40: pp. 3-18
- Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40: pp. 373-83 CrossRef
- Klabunde, C, Potosky, A, Legler, J, Warren, J (2000) Development of a comorbidity index using physician claims data. J Clin Epidemiol 53: pp. 1258-67 CrossRef
- Cabana, MD, Rand, CS, Powe, NR, Wu, AW, Wilson, MH, Abboud, PA, Rubin, HR (1999) Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 282: pp. 1458-1465 CrossRef
- Smith, MR, Egerdie, B, Toriz, NH (2009) Denusomab in men receiving androgen-deprivation therapy for prostate cancer. N Engl J Med 361: pp. 745-755 CrossRef
- Smith, MR, Morton, RA, Barnette, KG (2010) Toremifene to reduce fracture risk in men receiving androgen deprivation therapy for prostate cancer. J Urol 184: pp. 1316-1321 CrossRef
- Ito, K, Elkin, EB, Girotra, M, Morris, MJ (2010) Cost-effectiveness of fracture prevention in men who receive androgen deprivation therapy for localized prostate cancer. Ann Intern Med 152: pp. 621-629 CrossRef
- Shahinian, VB (2011) Prostate cancer: reducing fracture risk in men on androgen deprivation therapy. Nat Rev Urol 8: pp. 9-10 CrossRef
- King, AB, Fiorentino, DM (2011) Medicare payment cuts for osteoporosis testing reduced use despite tests’ benefit in reducing fractures. Health Aff 30: pp. 2362-2370 CrossRef
- Curtis, JR, Laster, AJ, Becker, DJ (2008) Regional variation in the denial of reimbursement for bone mineral density testing among US Medicare beneficiaries. J Clin Densitom 11: pp. 568-574 CrossRef
- Shahinian, VB, Kuo, YF, Freeman, JL, Orihuela, E, Goodwin, JS (2005) Increasing use of gonadotropin-releasing hormone agonists for the treatment of localized prostate carcinoma. Cancer 103: pp. 1615-1621 CrossRef
- Earle, CC, Burstein, HJ, Winer, EP, Weeks, JC (2003) Quality of non-breast cancer health maintenance among elderly breast cancer survivors. J Clin Oncol 21: pp. 1447-1451 CrossRef
- Earle, CC, Breville, BA (2004) Under use of necessary care among cancer survivors. Cancer 101: pp. 1712-1719 CrossRef
- Earle, CC (2006) Failing to plan is planning to fail: improving the quality of care with survivorship care plans. J Clin Oncol 24: pp. 5112-5116 CrossRef
- Patterns of Bone Mineral Density Testing in Men Receiving Androgen Deprivation for Prostate Cancer
Journal of General Internal Medicine
Volume 28, Issue 11 , pp 1440-1446
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- prostate cancer
- androgen deprivation therapy
- bone mineral density
- Industry Sectors
- Author Affiliations
- 1. Department of Internal Medicine, University of Michigan, 1415 Washington Heights, Room 3627, SPH I, Ann Arbor, MI, 48109-2029, USA
- 2. Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
- 3. Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
- 4. Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA