Androgen deprivation in veterans with prostate cancer: implications for skeletal health.
BACKGROUND
Common risk factors for osteoporosis in older men include smoking, heavy use of alcohol, propensity to falls, and use of bone-toxic medications such as prednisone. There is also increasing appreciation of the skeletal risk faced by men receiving androgen deprivation therapy (ADT) for prostate cancer. Measures to prevent bone loss in such patients are available.


OBJECTIVE
To test the following hypotheses in a population of veterans receiving ADT for prostate cancer: (1) fracture risk factors in addition to androgen deprivation would be found in most patients, (2) bone mass measurements would be assessed in a minority of patients, and (3) a minority of the subjects would receive bisphosphonate therapy or have contraindications for such treatment.


METHODS
We conducted a retrospective chart review of male veterans receiving ADT from 1993 through 2001, at the Veterans Affairs Medical Center, Madison, WI.


RESULTS
One hundred and seventy-four subjects met study criteria, with a mean age of 76 years and median duration of 21 months of ADT. Eighty-one percent had risk factors in addition to ADT. Only 13% underwent bone density measurement by dual energy X-ray absorptiometry (DXA) and, of those measured, more than half had osteoporosis. Only 19% of the men received both calcium and vitamin D supplements. Antiresorptive therapy was provided to 11% of men, although more than two-thirds had no contraindications to therapy. A total of 24 men sustained a fracture after starting ADT. For men who did undergo bone density measurement, 77% received antiresorptive therapy. Of those who exhibited osteoporosis by DXA scan, 85% received antiresorptive therapy.


CONCLUSIONS
Male veterans receiving ADT for prostate cancer received inadequate evaluation and treatment for osteoporosis. Based on our data, a simple and practical strategy to prompt further evaluation and improved care may be to undertake bone density measurements in men prior to or soon after commencing ADT.
Wilcox
Andrew
A
Rockford Veterans Affairs Clinic, Rockford, IL, USA.
Carnes
Molly L
ML
Moon
Timothy D
TD
Tobias
Renee
R
Baade
Heather
H
Stamos
Emily
E
Elliott
Mary E
ME
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000009:adverse effects / Q000494:pharmacology; D000728:Androgens / Q000097:blood*; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects* / Q000494:pharmacology; D015519:Bone Density / Q000187:drug effects* / Q000502:physiology; D050723:Fractures, Bone / Q000097:blood / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000097:blood / Q000139:chemically induced; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D014728:Veterans
D000726:Androgen Antagonists; D000728:Androgens; D018931:Antineoplastic Agents, Hormonal