Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Cancer. 2013 Feb 15;119(4):863-70. doi: 10.1002/cncr.27830. Epub 2012 Oct 12.
Androgen-deprivation therapy (ADT) causes bone loss and fractures. Guidelines recommend bone density testing before and during ADT to characterize fracture risk. The authors of the current report assessed bone density testing among men who received ADT for ≥ 1 year.
Surveillance, Epidemiology, and End Results/Medicare data were used to identify 28,960 men aged > 65 years with local/regional prostate cancer diagnosed from 2001 to 2007 who were followed through 2009 and who received ≥ 1 year of continuous ADT. Bone density testing was documented in the 18-month period beginning 6 months before ADT initiation. Logistic regression was used to identify the factors associated with bone density testing.
Among men who received ≥ 1 year of ADT, 10.2% had a bone density assessment from 6 months before starting ADT through 1 year after. Bone density testing increased over time (14.5% of men who initiated ADT in 2007-2008 vs 6% of men who initiated ADT in 2001-2002; odds ratio for 2007-2008 vs 2001-2002, 2.29; 95% confidence interval, 1.83-2.85). Less bone density testing was observed among men aged ≥ 85 years versus men ages 66 to 69 years (odds ratio, 0.76; 95% confidence interval, 0.65-0.89), among black men versus white men (odds ratio, 0.72; 95% confidence interval, 0.61-0.86), and among men in areas with lower educational attainment (P < .001). Men who visited a medical oncologist and/or a primary care provider in addition to a urologist had higher odds of testing than men who only consulted a urologist (P < .001).
Few men who received ADT for prostate cancer underwent bone density testing, particularly older men, black men, and those living in areas with low educational attainment. Visiting a medical oncologist was associated with increased odds of testing. Interventions are needed to increase bone density testing among men who receive long-term ADT. Data on bone density testing for nonmilitary populations of prostate cancer survivors in the United States who have received long-term androgen-deprivation therapy (ADT) have not been published. The current analysis of Surveillance, Epidemiology, and End Results/Medicare data suggests that few prostate cancer survivors who receive long-term ADT undergo bone density testing; and several key populations, including African Americans and older men, have considerably lower rates of bone density screening.
雄激素剥夺疗法（ADT）会导致骨质流失和骨折。指南建议在 ADT 前和 ADT 期间进行骨密度测试，以确定骨折风险。本报告的作者评估了接受 ADT 治疗≥1 年的男性的骨密度测试情况。
使用监测、流行病学和最终结果/医疗保险数据，确定了 2001 年至 2007 年期间被诊断为局部/区域前列腺癌且年龄>65 岁的 28960 名男性，这些男性接受了≥1 年的连续 ADT 治疗，并随访至 2009 年。在 ADT 开始前 6 个月开始的 18 个月期间记录骨密度测试情况。使用逻辑回归确定与骨密度测试相关的因素。
在接受≥1 年 ADT 的男性中，有 10.2%的人在开始 ADT 前 6 个月至 1 年后进行了骨密度评估。骨密度测试随着时间的推移而增加（2007-2008 年开始 ADT 的男性中有 14.5%进行了骨密度测试，而 2001-2002 年开始 ADT 的男性中有 6%进行了骨密度测试；2007-2008 年与 2001-2002 年相比，优势比为 2.29；95%置信区间为 1.83-2.85）。与年龄 66 至 69 岁的男性相比，年龄≥85 岁的男性（优势比，0.76；95%置信区间，0.65-0.89）、黑人男性（优势比，0.72；95%置信区间，0.61-0.86）和受教育程度较低地区的男性（P<0.001）接受骨密度测试的比例较低。与仅咨询泌尿科医生的男性相比，同时咨询肿瘤内科医生和/或初级保健医生的男性接受检测的可能性更高（P<0.001）。
很少有接受 ADT 治疗前列腺癌的男性接受骨密度测试，尤其是年龄较大的男性、黑人男性和受教育程度较低地区的男性。咨询肿瘤内科医生与接受骨密度测试的几率增加有关。需要采取干预措施，增加接受长期 ADT 治疗的男性进行骨密度测试的比例。关于接受长期雄激素剥夺治疗（ADT）的美国前列腺癌幸存者的非军事人群的骨密度测试数据尚未公布。对监测、流行病学和最终结果/医疗保险数据的当前分析表明，接受长期 ADT 治疗的前列腺癌幸存者中很少进行骨密度测试；包括非裔美国人和老年男性在内的几个关键人群的骨密度筛查率要低得多。
