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The implications of baseline bone-health assessment at initiation of androgen-deprivation therapy for prostate cancer.

  • Kirk, Peter S1
  • Borza, Tudor1
  • Shahinian, Vahakn B2
  • Caram, Megan E V3, 4
  • Makarov, Danil V5, 6
  • Shelton, Jeremy B7
  • Leppert, John T8, 9
  • Blake, Ryan M1
  • Davis, Jennifer A4
  • Hollenbeck, Brent K1
  • Sales, Anne4, 10
  • Skolarus, Ted A1, 4
  • 1 Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA.
  • 2 Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
  • 3 Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Health System, University of Michigan Medical School, Ann Arbor, MI, USA.
  • 4 Veterans Affairs (VA) Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, University of Michigan Medical School, Ann Arbor, MI, USA.
  • 5 Departments of Urology and Population Health, NYU Langone Medical Center, New York City, NY, USA.
  • 6 VA New York Healthcare System, New York City, NY, USA.
  • 7 VA Greater Los Angeles Healthcare System, Los Angeles City, LA, USA.
  • 8 Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
  • 9 VA Palo Alto Healthcare System, Palo Alto, CA, USA.
  • 10 Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.
Published Article
British Journal of Urology
Wiley (Blackwell Publishing)
Publication Date
Apr 01, 2018
DOI: 10.1111/bju.14075
PMID: 29124881


To assess bone-density testing (BDT) use amongst prostate cancer survivors receiving androgen-deprivation therapy (ADT), and downstream implications for osteoporosis and fracture diagnoses, as well as pharmacological osteoporosis treatment in a national integrated delivery system. We identified 17 017 men with prostate cancer who received any ADT between 2005 and 2014 using the Veterans Health Administration cancer registry and administrative data. We identified claims for BDT within a 3-year period of ADT initiation. We then used multivariable regression to examine the association between BDT use and incident osteoporosis, fracture, and use of pharmacological treatment. We found that a minority of patients received BDT (n = 2 502, 15%); however, the rate of testing increased to >20% by the end of the study period. Men receiving BDT were older at diagnosis and had higher-risk prostate cancer (both P < 0.001). Osteoporosis and fracture diagnoses, use of vitamin D ± calcium, and bisphosphonates were all more common in men who received BDT. After adjustment, BDT, and to a lesser degree ≥2 years of ADT, were both independently associated with incident osteoporosis, fracture, and osteoporosis treatment. BDT is rare amongst patients with prostate cancer treated with ADT in this integrated delivery system. However, BDT was associated with substantially increased treatment of osteoporosis indicating an underappreciated burden of osteoporosis amongst prostate cancer survivors initiating ADT. Optimising BDT use and osteoporosis management in this at-risk population appears warranted. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

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