medwireNews: Fewer than one in 10 older men initiating androgen deprivation therapy (ADT) for localized or regional prostate cancer receive dual-energy X-ray absorptiometry (DXA) screening to assess bone mineral density, US study findings indicate.
In spite of this, DXA screening is associated with a significantly reduced risk for major fractures, report Maria Suarez-Almazor (The University of Texas MD Anderson Cancer Center, Houston) and co-authors in JAMA Network Open.
Using data from the Surveillance, Epidemiology, and End Results database and the Texas Cancer Registry, the researchers identified 54,953 men aged 66 years and older (median 74 years) who were diagnosed with prostate cancer between 2005 and 2015. Of these, just 7.9% of underwent DXA screening within 12 months before and 6 months after their first Medicare claim for ADT.
The screening rate was 6.8% in 2005 and increased to 8.4% in 2015.
In multivariable analyses, a number of factors were associated with a reduced likelihood of receiving DXA screening including non-Hispanic Black race (odds ratio [OR]=0.80 vs non-Hispanic White), single status (OR=0.89 vs married), living in small urban areas (OR=0.77 vs large metropolitan) and areas with lower educational levels (OR=0.75 for lowest vs highest quartile), and receiving nonsteroidal androgens (OR=0.57 vs leuprolide).
Conversely, older age, living in certain states (New Mexico and Texas vs California), having regional or high-grade disease, comorbidity, receipt of the gonadotropin-releasing hormone agonists abarelix or degarelix or multiple types of ADT, previous fracture, and the presence of osteoporosis before ADT initiation were associated with an increased likelihood of DXA screening, with ORs typically below 1.5 but reaching 16.0 in the case of osteoporosis.
During a median 58 months of follow-up, 9365 (17.5%) men developed a fracture at any site and 4114 (7.7%) developed a major osteoporotic fracture (spine, upper arm, lower arm, hip, and other femur). The median time to first fracture was 31 months.
In a multivariable model that also included propensity score adjustment, the researchers found that DXA screening was not significantly associated with overall fracture risk among men with no history of fractures prior to ADT but was associated with a significant 9% lower risk for major fractures in these men.
The analysis also showed that men who received a DXA scan were more likely to receive a bone-modifying agent, such as bisphosphonate, than those who did not, at rates of 18.8% of 2136 participants with available data versus 1.8% of 25,266.
“Given the deleterious impact of fractures for morbidity and mortality, implementation strategies are needed to increase the uptake of current guidelines for bone health management among men with prostate cancer,” Suarez-Almazor et al remark.
They add: “Early intervention with bone-modifying agents could potentially reduce the burden of illness associated with fractures among older men who are survivors of prostate cancer.”
In an accompanying editorial, Amar Kishan (University of California, Los Angeles, USA) and co-authors note that the lack of information on ADT duration is a limitation of the study “given that at least 2 expert panels have suggested that DXA screening should be predominantly offered to men receiving long-term treatment with ADT.”
They say that the results may therefore underestimate “screening concordance with current guidelines.”
Nonetheless, the editorialists write that the study “highlights the fact that there is substantial room for improvement in evaluating bone health among patients with prostate cancer receiving ADT.”
“The low rate of DXA screening and the disparities in the use of DXA screening are concerning,” they add.
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JAMA Netw Open 2022; 5: e225432
JAMA Netw Open 2022; 5: e225439