Silent risk of osteoporosis in men with prostate cancer

Men being treated for prostate cancer using hormone therapy maybe under-recognized for their risk of developing osteoporosis, according to a new study.

Researchers writing in the January 15, 2005 issue of CANCER, a peer-reviewed journal of the American Cancer Society, say few patients get tested for osteoporosis during treatment. Moreover, even men with other risk factors for osteoporosis, such as smoking or receiving the hormone treatment for a long time, are still unlikely to receive prevention or treatment.

Osteoporosis is a disease characterized by brittle, easily fractured bones that is associated with significant morbidity, mortality, and healthcare cost. It is caused by dysregulation of the hormone-regulated bone remodeling system that leads to a loss of bone mineral density. Risk factors for male osteoporosis include age-associated hormone changes, alcoholism, smoking, some medications, including those used in the treatment of prostate cancer.

Osteoporosis can be prevented and even treated using a wide range of therapies. Common prevention measures include calcium and vitamin D supplements, regular exercise. Screening test such as the dual-energy X-ray absorptiometry (DXA) scan is also available. But, even now, there is no established national consensus guiding doctors of when and what to prescribe. Treatment strategies include bisphosphonates, which have been shown to prevent further bone loss, but it is inconvenient, sometimes expensive, and may cause serious side effects. 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. Fewer than one in ten (8.7 percent) received at least one DXA scan within three years, and only one in twenty (4.9 percent) was prescribed a bisphosphonate. The only 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.

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