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Guidelines Prompt Increased Osteoporosis Testing for Patients With Prostate Cancer Treated With Androgen Ablation: Presented at AACE

By Gabe Waggoner

HOUSTON, Tex -- May 17, 2009 -- The number of bone mineral density measurements significantly increased after the 2004 publication of guidelines from the British Columbia Cancer Agency addressing bone health and osteoporosis screening for prostate cancer patients treated with androgen ablation therapy, according to study results presented here at the American Association of Clinical Endocrinologists (AACE) 18th Annual Meeting & Clinical Congress.

Prostate cancer patients often undergo androgen ablation therapy, which unfortunately can result in osteoporosis and bone fractures. Guidelines from the British Columbia Cancer Agency stressed that physicians recommending androgen ablation therapy of least 6 months duration were obligated to also deal with concerns about osteoporosis. Previous studies indicated that doctors varied in their application of this guideline for numerous reasons.

Lindsay Van Tongeren, MD, University of British Columbia, Vancouver, British Columbia, and colleagues analysed the clinical implementation of these guidelines after reviewing the medical records of 400 British Columbia prostate cancer patients. She presented her team's findings here at a poster session on May 15.

The team reviewed the charts of patients who had undergone androgen ablation treatment before (2000 and 2001) and after (2005 and 2006) the guidelines were distributed. The authors determined whether guideline implementation was successful based on the likelihood of bone mineral density testing after patients started androgen ablation treatment.

Once the guidelines were published and distributed, the study authors found that bone mineral density measurements significantly increased, from 7.5% to 25% (P < .0001).

The group also analysed results from 4 distinct regional treatment centres to compare regional differences in bone mineral density testing. These findings indicated the existence of regional variance in guideline implementation. Bone mineral density testing at British Columbia's main academic and teaching institution, the Vancouver Centre, increased from 9% to 49.4%, the largest statistically significant increase (P < .0001).

Taking these findings collectively, Dr. Van Tongeren concluded that the guidelines for clinical practice did indeed have an effect on men with prostate cancer who were being treated with androgen ablation therapy.

"The data suggest a gradual increase in the number of bone mineral density tests ordered over time," Dr. Van Tongeren noted. "However, a relatively small population of patients in this high-risk group are being evaluated for osteoporosis, suggesting that there is still a significant gap between diagnostic test recommendations and practice."

She added that greater efforts are needed to carry out guidelines and to monitor adherence over time, as indicated by the care gap even at the provincial centre showing the greatest compliance.

[Presentation title: Implementation of Osteoporosis Screening Guidelines in Prostate Cancer Patients on Androgen Ablation. Abstract 506]

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