Background: Low bone mineral density (BMD) is an under-diagnosed issue prevalent in older men. This issue is compounded by exposure to androgen deprivation therapy (ADT) which is commonly used in the treatment of prostate cancer, with a two-to-sevenfold acceleration in bone loss during the first 12 months of ADT (1). Despite this, an Australian study showed around 80% of men with prostate cancer on ADT were not assessed with a dual-energy X-ray absorptiometry (DXA) of bone health (2). Another local study of 236 men with a mean age of 70 newly commencing androgen deprivation therapy (ADT) for prostate cancer showed 11% had osteoporosis and 40% had osteopenia (3), representing an underdiagnosed yet treatable health concern.
Objective: to assess the utility and projected cost-benefit savings of a bone health and fracture prevention clinic targeting men with prostate cancer commencing, continuing, or recently treated with ADT to diagnose and treat poor bone health. Secondarily, assess changes in specialist clinician behaviours in referring patients for bone health investigations after dissemination of local bone health investigation flowchart.
Design: single centre, investigative and interventional study with initial and 12 month follow up.
Participants: Men (18 years or older) being treated for prostate cancer with ADT, identified by their specialist (Radiation Oncologist, Medical Oncologist, or Urologist) as having risk factors for poor bone health.
Outcome measures: number of individuals identified to have osteopenia, osteoporosis, and prior minimal trauma fracture; number of individuals commenced on anti-resorptive therapy; number of subsequent fractures on follow-up; and pre and post-clinic health patient behaviours relating to non-pharmacologic strategies for bone health optimisation.
Results: 175 individuals attended the initial clinic appointment between Nov 2018 to Nov 2022. Primary analysis of DXA results, previous and subsequent minimal trauma fractures, treatment rates, and changes in health behaviours between initial and follow up including follow up rates will be presented. Secondary analysis of changes in specialist clinician referral behaviours following dissemination of local referral guidelines will also be presented.