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ONCOLOGY

Androgen Deprivation in Veterans with Prostate Cancer: Implications for Skeletal Health

Clinical Pharmacist, Rockford Veterans Affairs Clinic, Rockford, IL

Molly L Carnes, MD MS

Professor, Departments of Medicine, Psychiatry, and Industrial & Systems Engineering, School of Medicine and Public Health, University of Wisconsin, Madison, WI; Director, Women Veterans Clinic, Veterans Affairs Medical Center, Madison; Director, University of Wisconsin Center for Women's Health Research, Madison

Timothy D Moon, MD

Professor of Surgery and Urology, School of Medicine, University of Wisconsin; Chief of Urology, Veterans Affairs Medical Center, Madison

Renee Tobias

PharmD Student, School of Pharmacy, University of Wisconsin

Heather Baade

PharmD Student, School of Pharmacy, University of Wisconsin

Emily Stamos

PharmD Student, School of Pharmacy, University of Wisconsin

Mary E Elliott, PharmD PhD

Associate Professor, School of Pharmacy, University of Wisconsin; Clinical Pharmacist, Veterans Affairs Medical Center, Madison

Reprints: Dr. Elliott, University of Wisconsin School of Pharmacy, 777 N. Charter St., Madison WI 53705-2222, fax 608/265-5421, meelliott{at}pharmacy.wisc.edu

BACKGROUND: Common risk factors for osteoporosis in older men include smoking, heavy use of alcohol, propensity to falls, and use of bone-toxic medications such as prednisone. There is also increasing appreciation of the skeletal risk faced by men receiving androgen deprivation therapy (ADT) for prostate cancer. Measures to prevent bone loss in such patients are available.

OBJECTIVE: To test the following hypotheses in a population of veterans receiving ADT for prostate cancer: (1) fracture risk factors in addition to androgen deprivation would be found in most patients, (2) bone mass measurements would be assessed in a minority of patients, and (3) a minority of the subjects would receive bisphosphonate therapy or have contraindications for such treatment.

METHODS: We conducted a retrospective chart review of male veterans receiving ADT from 1993 through 2001, at the Veterans Affairs Medical Center, Madison, WI.

RESULTS: One hundred and seventy-four subjects met study criteria, with a mean age of 76 years and median duration of 21 months of ADT. Eighty-one percent had risk factors in addition to ADT. Only 13% underwent bone density measurement by dual energy X-ray absorptiometry (DXA) and, of those measured, more than half had osteoporosis. Only 19% of the men received both calcium and vitamin D supplements. Antiresorptive therapy was provided to 11% of men, although more than two-thirds had no contraindications to therapy. A total of 24 men sustained a fracture after starting ADT. For men who did undergo bone density measurement, 77% received antiresorptive therapy. Of those who exhibited osteoporosis by DXA scan, 85% received antiresorptive therapy.

CONCLUSIONS: Male veterans receiving ADT for prostate cancer received inadequate evaluation and treatment for osteoporosis. Based on our data, a simple and practical strategy to prompt further evaluation and improved care may be to undertake bone density measurements in men prior to or soon after commencing ADT.

Key Words: androgen deprivation, osteoporosis, prostate cancer

Published Online, November 28, 2006. www.theannals.com, DOI 10.1345/aph.1H209