Physician practices of bone density testing and drug prescribing to prevent or treat osteoporosis during androgen deprivation therapy.
BACKGROUND
Androgen deprivation therapy (ADT) is a strong risk factor for osteoporosis. The current study identified physician practices in preventing or treating osteoporosis during ADT. The practices of interest are the uses of dual-energy X-ray absorptiometry (DXA) scans, bisphosphonates, calcium or vitamin D supplement, calcitonin, or estrogen.


METHODS
A retrospective medical record review was conducted. Patients were included if they had received ADT with goserelin injection for >/= 1 year. Multivariable logistic regression analysis was performed to identify independent predictors of receiving at least one intervention.


RESULTS
Analyses included 184 patients. Most were the elderly with multiple risk factors for osteoporosis. Only 8.7% (95% confidence interval [CI], 4.6-13.0%) of patients received a DXA scan at least once during the past 3 years. Oral and intravenous bisphosphonates were prescribed in 4.9% (95%CI, 1.8-8.0%) and 0.5% (95%CI, 0-2.0%) of patients, respectively, during the past year. Overall, 14.7% of patients (95%CI, 9.5-20.0%) received at least one intervention. Concurrent risk factors for osteoporosis, including smoking, alcoholism, advanced age, low body mass index, long duration of ADT, multiple comorbidities, history of fractures, and steroid use, were not independent predictors of having received interventions. However, bone metastasis was, with a hazard ratio of 5.6 (95%CI, 1.99-15.6%). Primary care physicians provided the greatest number of interventions and cancer-related specialists provided the fewest.


CONCLUSIONS
The majority of patients with prostate carcinoma undergoing ADT did not receive interventions to prevent or treat osteoporosis. Having other concurrent risk factors for osteoporosis was not predictive of receiving these few interventions.
Tanvetyanon
Tawee
T
Division of Hematology and Oncology, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois 60153, USA. ttanve@lumc.edu
D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D015519:Bone Density / Q000502:physiology; D016001:Confidence Intervals; D004164:Diphosphonates / Q000627:therapeutic use; D004363:Drug Utilization; D005500:Follow-Up Studies; D017273:Goserelin / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010024:Osteoporosis / Q000139:chemically induced* / Q000175:diagnosis* / Q000188:drug therapy; D010818:Practice Patterns, Physicians'; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000188:drug therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000726:Androgen Antagonists; D004164:Diphosphonates; D017273:Goserelin