PSA Rising, December 13, 2004. Men who are in treatment for prostate cancer using hormone therapy are not receiving the protection they need to prevent crippling osteoporosis.
Currently, a study has found, just 1 out of 7 prostate cancer patients who need protection against osteoporosis to prevent serious fractures actually gets it. Primary care physicians were the most aggressive at managing osteoporosis while cancer specialists were the least.
Researchers writing in the January 15, 2005 issue of CANCER, a peer-reviewed journal of the American Cancer Society, say few prostate cancer patients are ever tested for osteoporosis during hormonal therapy treatment. This widely used type of treatment deprives the man's body of the male hormone testosterone. One effect of this is to cause osteoporosis, which in some men happens within the first six months of therapy.
Even men with other known risk factors for osteoporosis, such as smoking or receiving the hormone treatment for a long time, are unlikely to receive prevention or treatment.
Osteoporosis is a disease characterized by brittle, easily fractured bones. It is associated with major ill-effects including hip fracture, which can cause lasting disability or death. Private health insurers and Medicare have an interest in preventing osteoporosis because it adds significantly to healthcare costs.
Osteoporosis occurs when disregulation of the hormone-regulated bone remodeling system leads to a loss of bone mineral density. Risk factors for male osteoporosis include age-associated hormone changes, alcoholism, smoking, and.or some medications, including those used in the treatment of prostate cancer.
Screening tests such as Dual-energy X-ray absorptiometry (DXA) scan are available. But so far there is no established national consensus guiding doctors on when and what to prescribe.
Osteoporosis can be prevented and even treated using a wide range of therapies. Common prevention measures include calcium and vitamin D supplements and regular exercise.
Treatment strategies include bisphosphonates, which have been shown to prevent further bone loss.
[Update: bisphosphonatres have since been shown to carry risks of avascular necrosis including to the jaw after tooth extraction].
The extent of the problem
To find out how clinicians were managing osteoporosis risk in the U.S. in year 2003 and identify factors that might predict who gets treated, Tawee Tanvetyanon, M.D. from Loyola University Chicago Stritch School of Medicine reviewed the sampled records of 184 prostate cancer patients who received androgen deprivation therapy (ADT), which is known to raise the risk of osteoporosis.
Dr. Tanvetyanon found that "the majority of patients undergoing ADT did not receive osteoporosis prevention or treatment," even when they reported other risk factors, as well.
Only about one in seven (14.7 percent) eligible patients received any sort of osteoporosis management.
Only one in ten (8.7 percent) received at least one DXA scan within three years.
Only one in twenty (4.9 percent) was prescribed a bisphosphonate.
The one factor that predicted clinical management of osteoporosis risk and disease was the presence of bony metastases (prostate cancers that had spread to the bones). Analysis also showed that primary care physicians were the most aggressive at managing osteoporosis while cancer specialists were the least.
Article: "Physician Practices of Bone Density Testing and Drug Prescribing to Prevent or Treat Osteoporosis during Androgen Deprivation Therapy," Tawee Tanvetyanon, CANCER; Published Online: December 13, 2004 Print Issue Date: January 15, 2005.
This article edited by J. Strax, updated December 13, 2004 and May 2015.