Men being treated for prostate cancer using hormone therapy may be under-recognized for their risk of developing osteoporosis, according to a new study.
Researchers writing in the January 15, 2005 issue of Cancer (http://www.interscience.wiley.com/cancer-newsroom), a peer-reviewed journal of the American Cancer Society, say few patients are tested for osteoporosis during treatment. Moreover, even men with other risk factors for osteoporosis, such as smoking or receiving hormone treatment for a long time, are still unlikely to receive preventative treatment.
Read: Receiving hormone treatment
Osteoporosis is a disease characterized by brittle, easily fractured bones, associated with significant morbidity, mortality, and healthcare cost. It is caused by dysregulation of the hormone-regulated bone remodelling system, leading to a loss of bone mineral density.
No national consensus
Risk factors for male osteoporosis include age-associated hormone changes, alcoholism, smoking and 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 preventative measures include calcium and vitamin D supplements and regular exercise.
Read: How osteoporosis can be prevented
Screening tests such as the dual-energy X-ray absorptiometry (DXA) scan are also available. But, even now, there is no established national consensus guiding doctors about when and what to prescribe.
Treatment strategies include bisphosphonates, which have been shown to prevent further bone loss, but this is inconvenient, sometimes expensive, and may cause serious side effects.
To find out how clinicians were managing osteoporosis risk in the US in 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.
Read: Androgen deprivation therapy
Other risk factors
Dr. Tanvetyanon found that "the majority of patients undergoing ADT did not receive osteoporosis prevention or treatment", even when they reported other risk factors. Only about one in seven (14.7 percent) of 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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