Rates of bone mineral density measurement in men with prostate cancer starting androgen deprivation therapy.

Abstract

174 Background: Men with prostate cancer on androgen deprivation therapy (ADT) are at risk for accelerated bone loss and osteoporotic fractures. Current National Comprehensive Cancer Network (NCCN) guidelines recommend dual-energy X-ray absorptiometry (DXA) scan for risk assessment when starting ADT. Our objective was to determine if DXA scans were performed prior or soon after ADT initiation among men with prostate cancer. Methods: In this claims-based database linkage study, men with prostate cancer were identified fromthe Texas Cancer Registry between 2006-2007 and their records were linked with Medicare databases parts A, B and D to identify claims for ADT using generic names, predefined J codes and ICD codes. Part D claims are currently available for years 2007 and 2008. DXA claims were obtained using CPT/HCPS codes from Medicare part A and part B. Patients were considered to have undergone a DXA exam, useful as a baseline screening test for ADT therapy if a claim could be identified within 2 years before starting ADT therapy, or 6 months afterwards. Multivariate logistic regression models were performed to examine determinants of DXA use. Results: 1,647 men 65 years and older were included in the study. A total of 144 (8.3%) had a DXA scan obtained within 2 years and 6 months after initiation of ADT. Age older than 75 years, history of prior bisphosphonate usage and residence in the metropolitan area were statistically significantly associated with higher likelihood of obtaining DXA. Race, gender, median income, high school percentage, number of ADT claims, and type of ADT used were not associated with DXA usage. Conclusions: Despite the importance of osteoporosis screening, men with prostate cancer and Medicare insurance, in the state of Texas, had very low DXA utilization rates prior, or soon after, the initiation of ADT. Further research is needed to identify barriers to adherence to recommendations for the evaluation of bone health in patients with prostate cancer.