Bone health management suboptimal in prostate cancer patients

NEW YORK (Reuters Health) - Few men with prostate cancer undergoing androgen-deprivation therapy (ADT) are told about effects on bone density, and prevention efforts are not usual, according to a report in the March issue of BJU International.

"Bone side effects of ADT are real and important," Dr. Shabbir M. H. Alibhai from the University Health Network, Toronto, Ontario, Canada, told Reuters Health. "We need to do a better job in telling patients about this and screening for osteoporosis."

Dr. Alibhai and colleagues assessed bone health management practices using both clinician-reported documentation of patient encounters and patient interviews in 66 men starting ADT for non-metastatic prostate cancer.

Before starting ADT, 28 of the men (42%) had normal bone mineral density (BMD), 35 (53%) had osteopenia, and 3 (5%) had osteoporosis.

All patients were seen in clinic 3 and 6 months after their diagnosis, the authors report, but the results of BMD tests were discussed with only 21% of patients by 3 months and 32% by 6 months.

General side effects of ADT were discussed with 26% of all patients, and bone-specific side effects were documented to have been discussed with 15%.

Lifestyle changes to preserve bone health were discussed with only 11% of all patients, and pharmacological interventions were recommended to 18%, including 26% of men with osteopenia and 2 of 3 men with osteoporosis.

Within 6 months of beginning ADT, 23% of men reported taking calcium and 38% reported taking vitamin D. Only 1 patient was taking a bisphosphonate at that point.

"There is a large body of literature showing that patient-physician communication is suboptimal in a variety of areas of medicine," Dr. Alibhai said. "I thought physicians at our academic centre would do better, particularly with recent attention being given to the bone side effects of ADT."

Dr. Alibhai suggested routinely providing appropriate written information about side effects of ADT to patients. "I do not believe many practices do this currently," he said.

Also, Dr. Alibhai added, "Multidisciplinary clinics may help patients deal with the many side effects of ADT better than an individual clinician."

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