Utilization of bone densitometry and administration of bisphosphonates to prevent osteoporosis in patients with nonmetastatic prostate cancer receiving anti-androgen therapy.

Abstract

6099 Background: Prostate cancer subjects with PSA relapse who are treated with androgen deprivation therapy (ADT) are recommended to have baseline and serial bone densitometry (BD) and receive intravenous bisphsphonates (BP). Utilization of BD and BP therapy was evaluated in a retrospective SEER Medicare database analysis. Methods: A cohort study of men aged aged ≥ 65 years with a nonmetastatic incident diagnosis of prostate cancer between 2004 and 2008 was conducted. Data were obtained from the Surveillance, Epidemiology and End Results (SEER) linked Medicare claims. Medicare claims were used to select prostate cancer cases who had ever received ADT and intravenous BP as part of their treatment. ADT was defined as an orchiectomy, goserelin, leuprolide, leuprolide implant, or triptorelin. BD and treatment with pamidronate or zoledronic acid were identified using Medicare HCPCS codes. One-sided exact binomial test of proportion was used to determine if the physician compliance rate is consistent with 80%; meaning equal to or higher than 80%. Results: 157,974 newly diagnosed prostate cancer cases were identified. Of those, 100,865 were age 65 and above and had no bone metastases. Subjects who did not have ADT claims were excluded. 30,846 patients were eligible for analysis. Cases were further stratified by use of BD and BP therapy. Results revealed 86.8% (N=26,774) on ADT did not receive either a BD or intravenous BP therapy. Approximately 2.9% (N=885) of the cases on ADT received BP treatment without ever receiving a BD. 9.3% (N=2,863) of the cases on ADT received a BD without receiving intravenous BP, while only 1.05% (N=324) of the cases on ADT received both a BD and BP. A compliance rate of 1.05%, those patients receiving both bone densitometries to screen for bone loss and preventive therapy, was well below the expected rate of 80%. Conclusions: Contrary to the recommendations, BD assessment and BP use is under utilized in men receiving ADT for non metastatic prostate cancer. Education of practicing physicians regarding better screening and preventative measures for osteoporosis in this population is warranted.