Assessment of osteoporosis risk in men with prostate cancer receiving androgen-deprivation-therapy: a cross-sectional descriptive study using a primary care audit database

Problem

Osteoporosis in men is often under-diagnosed and under-treated. Androgen deprivation therapy (ADT) is a common treatment for prostate cancer (PC), but can also adversely affect bone health causing increased risk of osteoporosis and fragility fractures. As men live longer with PCa, more people will receive ADT for a long period of time. Our aim was to evaluate how the risk of osteoporosis was assessed for men with PCa receiving ADT in a primary care population.

Approach

We undertook a cross-sectional descriptive study using routine audit data that were extracted by hand-searching records of PCa patients identified using SNOMED codes. FRAX-TM and NOGG guidelines were used for fracture risk assessment. The primary outcome was the fracture risk assessment gap: the proportion who require ADT with high risk but didn’t receive a fracture risk assessment or DXA scan.

Findings

Of 53 patients identified with PCa (aged 53-90), half (27 men) have had ADT – 32% (17/53) current treatment (10 metastasis, 7 localised advanced); 19% (10/53) had previous ADT. The average ADT duration was 35 months. No documentation of FRAX assessment in any man on ADT. One patient underwent a DXA scan as part of a research project; 4 had DXA for other causes. The median 10-year probability of fracture was 5.55 (hip) and 10.48 (osteoporotic) in patient receiving current ADT compared with 3.02 (hip) and 7.04 (osteoporotic) without respectively (p<0.05). 53% (9/17) men with current ADT were recommended a DXA scan (NOGG amber risk). Age was another risk factor.

Consequences

There is an unmet need to assess fragility fracture risk and intervene in men with PCa taking ADT. As men live longer with cancer, clinicians in primary care will get more involved in the management of cancer treatment induced complications.