SUN-536 Assessment of Bone Health Status in Veterans Requiring Androgen-Deprivation Therapy for Prostate Cancer

Abstract

Prostate cancer (PC) is the most common cancer in general (25%) and Veteran (33%) population. Amongst the PC patients who develop fractures, 11% have clinically silent osteoporosis (OP) and 40% have low bone mass (LBM) at the start of androgen-deprivation therapy (ADT) namely GnRH analogue (GRA) +/- Androgen receptor blockers (ARB). Further, ADT is associated with 4-7% bone mineral density (BMD) loss at hip and spine in the first year of treatment. To attain better preventive bone health care (PBHC) in this population, a collaborative care protocol was initiated in 2010 for Urology providers. To study the efficacy of protocol on the quality of PBHC in PC patients receiving ADT, assess incident OP and, prevention and treatment of OP. A retrospective chart review of 186 PC patients who received ADT from 2010 through 2013 was done. Study cohort was identified with pharmacy database query of patients receiving ADT agents and then matched ADT naive patients with diagnosis of pathologically confirmed PC. We assessed demographics (age, ethnicity), PC disease state- Gleason score (GS) and metastatic disease (MD), risk factors for fall/poor bone health (RF), fragility fracture (FFX) history, serum 25OH Vitamin D (SVD) and Dual Energy X-ray absorptiometry assessment (DXA) between 0-12 months of ADT start, frequency of vitamin D (VD) and calcium supplements (Ca), fall prevention counseling (FPC), and anti-resorptive therapy (ART) over 12 months. We excluded 59 cases due to incomplete data, h/o ADT exposure, or patients who moved or passed away prior to the end of study period. Continuous measures are presented as means (+/-SD) and categorical measures as frequencies and percentages (% of 127). Data analyzed using SAS 9.4. The study cohort consisted of 127 male veterans, average (avg) age 69.6 (+/-8.6) year with 79% Caucasians, avg GS 7.8(+/-2.2), 74% had 1-6 RF, 30% had MD, and 8% had h/o FFX. In this cohort, 78% received dual ADT (GRA+ARB) and 17% received ART. Within the study period, 42.5% had DXA, and 24% had SVD measured. Within the cohort, none had FPC, and prescription rates were 72% for VD and 75% for Ca. Of the 54 patients with DXA, 39% had LBM, 54% had normal BMD, 7% had OP. Of the newly diagnosed OP (7%), 75% had ART and 100% had Ca/ VD therapy. Amongst ART recipients in the complete cohort, 91% were on dual ADT, 81% had MD with avg GS of 8, and 13% had OP on DXA. In patients with h/o FFX, 80% received Ca/VD and 10% had ART. As compared to the current literature, our cohort had higher PBHC measures i.e. increased DXA and SVD assessments, and improved rates of Ca/VD therapy. Rate of ART remained low in FFX patients but improved when OP was noted on DXA. Dual ADT therapy led to higher use of ART. Given the integrated healthcare system with robust electronic medical records, an automated protocol with built-in guidelines can help in timely identification, monitoring, and therapy of PC patients who are at risk of bone loss/fracture.