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Supportive Care in Cancer

, Volume 20, Issue 10, pp 2287–2294 | Cite as

Promoting calcium and vitamin D intake to reduce the risk of osteoporosis in men on androgen deprivation therapy for recurrent prostate cancer

  • B. Joyce DavisonEmail author
  • Kristin Wiens
  • Meredith Cushing
Original Article

Abstract

Purpose

The aim of this study was to measure the impact of a patient education intervention aimed at increasing dietary intake of calcium and vitamin D in patients currently on androgen deprivation therapy (ADT) for the treatment of prostate cancer.

Methods

Sixty-one participants attended a one-time dietitian-delivered group education session focusing on diet and lifestyle strategies to reduce the risk of bone loss while on ADT. Dietary intake was assessed using the diet history questionnaire at baseline and again at approximately 1 year post-intervention. Demographics, medical history (including comorbidities), awareness of developing bone loss while on ADT, and information resources utilized were recorded at baseline.

Results

Fifty-one participants completed both time points. Over one third of men did not meet minimum current clinical guidelines for calcium or vitamin D intake at baseline. Sixty-three percent of men reported they were aware that osteoporosis was a known side effect of ADT therapy. Only supplemental calcium intake was significantly increased after the intervention. Men aware of their risk of developing bone loss while on ADT reported higher baseline calcium intake (p ≤ 0.05). Men undergoing ADT for less than 1 year at the time of intervention had significantly higher total calcium intake at follow-up compared to men on ADT for longer than 1 year (p = 0.038). Nonsignificant trends indicated that calcium and vitamin D intakes changed to a greater degree in those undergoing ADT for less than 1 year as well.

Conclusions

Total calcium and vitamin D did not change significantly as a result of the intervention. Results suggest that promotion of dietary changes may be more effective if delivered closer to the initiation of therapy.

Keywords

Prostate cancer Androgen deprivation therapy Nutrition Osteoporosis Patient education 

Notes

Acknowledgments

Funds for this study were provided by the British Columbia Foundation for Prostate Disease. Sincere thanks to Drs. Larry Goldenberg, Martin Gleave, and Alan So for assistance in patient recruitment. We are also grateful to Erin Breckon and Morag Yule who assisted in data collection and data management.

References

  1. 1.
    Sharifi N, Gulley JL, Dahut WL (2010) An update on androgen deprivation therapy for prostate cancer. Endocr Relat Cancer 17:305–315CrossRefGoogle Scholar
  2. 2.
    Michaelson MD, Cotter SE, Gargollo PC, Zietman AL, Dahl DM, Smith MR (2008) Management of complications of prostate cancer treatment. CA Cancer J Clin 58:196–213PubMedCrossRefGoogle Scholar
  3. 3.
    Wei JT, Gross M, Jaffe CA, Gravlin K, Lahaie M, Faerber GJ et al (1999) Androgen deprivation therapy for prostate cancer results in significant loss of bone density. Urology 54:607–611PubMedCrossRefGoogle Scholar
  4. 4.
    Kiratli BJ, Srinivas S, Perkash I, Terris MK (2001) Progressive decrease in bone density over 10 years of androgen deprivation therapy in patients with prostate cancer. Urology 57:127–132PubMedCrossRefGoogle Scholar
  5. 5.
    Daniell HW, Dunn SR, Ferguson DW, Lomas G, Niazi Z, Stratte PT (2000) Progressive osteoporosis during androgen deprivation therapy for prostate cancer. J Urol 163:181–186PubMedCrossRefGoogle Scholar
  6. 6.
    Kiebzak GM, Beinart GA, Perser K, Ambrose CG, Siff SJ, Heggeness MH (2002) Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med 162:2217–2222PubMedCrossRefGoogle Scholar
  7. 7.
    Dickman PW, Adolfsson J, Astrom K, Steineck G (2004) Hip fractures in men with prostate cancer treated with orchiectomy. J Urol 172:2208–2212PubMedCrossRefGoogle Scholar
  8. 8.
    Malcolm JB, Derweesh IH, Kincade MC, DiBlasio CJ, Lamar KD, Wake RW et al (2007) Osteoporosis and fractures after androgen deprivation initiation for prostate cancer. Can J Urol 14:3551–3559PubMedGoogle Scholar
  9. 9.
    Saad F, Abrahamsson PA, Miller K (2009) Preserving bone health in patients with hormone-sensitive prostate cancer: the role of bisphosphonates. BJU Int 104:1573–1579PubMedCrossRefGoogle Scholar
  10. 10.
    Saad F, Higano CS, Sartor O, Colombel M, Murray R, Mason MD et al (2006) The role of bisphosphonates in the treatment of prostate cancer: recommendations from an expert panel. Clin Genitourin Cancer 4:257–262PubMedCrossRefGoogle Scholar
  11. 11.
    Wiens K, Barr SI (2011) Dietary risk factors for bone loss among men undergoing androgen deprivation therapy for the treatment of prostate cancer. University of British Columbia, MSc Thesis; (manuscript in progress)Google Scholar
  12. 12.
    Smith MR, McGovern FJ, Fallon MA, Schoenfeld D, Kantoff PW, Finkelstein JS (2001) Low bone mineral density in hormone-naive men with prostate carcinoma. Cancer 91:2238–2245PubMedCrossRefGoogle Scholar
  13. 13.
    National Institute of Health (2007) Diet History Questionnaire. Available at: http://riskfactor.cancer.gov/DHQ/forms
  14. 14.
    Csizmadi I, Kahle L, Ullman R, Dawe U, Palmer Zimmerman T, Friedenreich CM, Bryant H, Subar AF (2007) Adaptation and evaluation of the National Cancer Institute’s Diet History Questionnaire and nutrient database for Canadian populations. Public Health Nutr 10:88–96PubMedCrossRefGoogle Scholar
  15. 15.
    BC Cancer Agency (2008) Guidelines for the prevention of osteoporosis for men with prostate cancer on hormone therapy. BC Cancer Agency, Vancouver, BC. Available at: http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Genitourinary/Prostate/Osteo/PatientPamphlet.htm
  16. 16.
    Health Canada (2007) Eating well with Canada's food guide. Health Canada, Ottawa, ON. Available at: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php
  17. 17.
    Committee to Review Dietary Reference Intakes for Vitamin D and Calcium (2010) Dietary Reference Intakes for Calcium and Vitamin D. Institute of Medicine, Washington, DCGoogle Scholar
  18. 18.
    Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S et al (2010) 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 182:1864–1873PubMedCrossRefGoogle Scholar
  19. 19.
    Forster-Coull L, Levy Milne R, Barr SI (2004) British Columbia nutrition survey. Ministry of Health Services, Health Canada and University of British ColumbiaGoogle Scholar
  20. 20.
    Planas J, Morote J, Orsola A, Salvador C, Trilla E, Cecchini L et al (2007) The relationship between daily calcium intake and bone mineral density in men with prostate cancer. BJU Int 99:812–815PubMedCrossRefGoogle Scholar
  21. 21.
  22. 22.
    Green TJ, Barr SI, Chapman GE (2010) The majority of older British Columbians take vitamin D-containing supplements. Can J Public Health 101:246–250PubMedGoogle Scholar
  23. 23.
    Health Canada and Statistics Canada (2004) Canadian community health survey, cycle 2.2, nutrition—nutrient intakes from food: provincial, regional and national summary data tables, volume 1, 2 and 3Google Scholar
  24. 24.
    Poliquin S, Joseph L, Gray-Donald K (2009) Calcium and vitamin D intakes in an adult Canadian population. Can J Diet Pract Res 70:21–27PubMedCrossRefGoogle Scholar
  25. 25.
    Moore C, Murphy MM, Keast DR, Holick MF (2004) Vitamin D intake in the United States. J Am Diet Assoc 104:980–983PubMedCrossRefGoogle Scholar
  26. 26.
    Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Earlbaum Associates, HillsdaleGoogle Scholar
  27. 27.
    Alibhai SM, Duong-Hua M, Cheung AM, Sutradhar R, Warde P, Fleshner NE et al (2010) Fracture types and risk factors in men with prostate cancer on androgen deprivation therapy: a matched cohort study of 19,079 men. J Urol 184:918–923PubMedCrossRefGoogle Scholar
  28. 28.
    Conde FA, Aronson WJ (2003) Risk factors for male osteoporosis. Urol Oncol 21:380–383PubMedCrossRefGoogle Scholar
  29. 29.
    Tanvetyanon T (2005) Physician practices of bone density testing and drug prescribing to prevent or treat osteoporosis during androgen deprivation therapy. Cancer 103:237–241PubMedCrossRefGoogle Scholar
  30. 30.
    Panju AH, Breunis H, Cheung AM, Leach M, Fleshner N, Warde P et al (2009) Management of decreased bone mineral density in men starting androgen-deprivation therapy for prostate cancer. BJU Int 103:753–757PubMedCrossRefGoogle Scholar
  31. 31.
    Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM (2005) Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Onco 23:5814–5830CrossRefGoogle Scholar
  32. 32.
    Stull VB, Snyder DC, Demark-Wahnefried W (2007) Lifestyle interventions in cancer survivors: designing programs that meet the needs of this vulnerable and growing population. J Nutr 137:243S–248SPubMedGoogle Scholar
  33. 33.
    Lawson PJ, Flocke SA (2009) Teachable moments for health behavior change: a concept analysis. Patient Educ Couns 76:25–30PubMedCrossRefGoogle Scholar
  34. 34.
    Greenspan SL, Coates P, Sereika SM, Nelson JB, Trump DL, Resnick NM (2005) Bone loss after initiation of androgen deprivation therapy in patients with prostate cancer. J Clin Endocrinol Metab 90:6410–6417PubMedCrossRefGoogle Scholar
  35. 35.
    Kipnis V, Midthune D, Freedman L, Bingham S, Day NE, Riboli E et al (2002) Bias in dietary-report instruments and its implications for nutritional epidemiology. Public Health Nutr 5:915–923PubMedCrossRefGoogle Scholar
  36. 36.
    Sebring NG, Denkinger BI, Menzie CM, Yanoff LB, Parikh SJ, Yanovski JA (2007) Validation of three food frequency questionnaires to assess dietary calcium intake in adults. J Am Diet Assoc 107:752–759PubMedCrossRefGoogle Scholar
  37. 37.
    Subar AF, Thompson FE, Kipnis V, Midthune D, Hurwitz P, McNutt S et al (2001) Comparative validation of the Block, Willett, and National Cancer Institute food frequency questionnaires: the Eating at America's Table Study. Am J Epidemiol 154:1089–1099PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • B. Joyce Davison
    • 1
    Email author
  • Kristin Wiens
    • 2
  • Meredith Cushing
    • 3
  1. 1.College of NursingUniversity of SaskatchewanSaskatoonCanada
  2. 2.Mount Royal UniversityCalgaryCanada
  3. 3.Vancouver Prostate CentreVancouverCanada

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