Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Proactively Contacting Men with Prostate Cancer Treated with Anti-Androgen Medications Improves the Evaluation and Treatment of Osteoporosis.
Oppermann1, Brian P., Harrington2, Thomas M., Ayoub3, William
Men treated with androgen deprivation therapy for prostate cancer are at higher risk for osteoporosis and osteoporotic fractures. This relationship is dose and length of therapy dependent. Despite this known association, men treated with anti-androgen therapy do not routinely receive osteoporosis screening with dual energy X-ray absorptiometry (DXA).
Using an electronic health record (EHR), in a rural tertiary health care system, we identified 64 men followed by our primary care physicians with the diagnosis of prostate cancer who have been treated with anti-androgen therapy (leuprolide acetate) for this pilot study. This EHR search identified any man who met the above criteria from 20072009. Of these 64 men, 61 had not undergone osteoporosis screening with DXA scanning. The other 3 men had undergone DXA and one was on bisphosphonate therapy. These three men were excluded. The remaining evaluation naïve 61 men were then contacted via letter. This letter explained reasons that they were being contacted, mainly they may be at high risk for osteoporosis given treatment with anti-androgen therapy. The letter instructed them to call to schedule a DXA scan. If no response was obtained several weeks after the mailing, patients were contacted by telephone to schedule the DXA scan. From initial contact via letter to scheduling the men for evaluation took 4 months.
For the pilot study, 30 of the 61 men contacted agreed to osteoporosis screening with DXA scanning. Of these 30 DXA's, 18 (60%) were low/moderate risk and 12 (40%) were deemed high risk for fracture (osteoporotic) using the 2008 National Osteoporosis Foundation criteria. None of these 12 high risk DXA scan patients had been on bisphosphonate therapy prior to this project, with all 12 being placed on therapy after DXA results.
Using our EHR, we proactively captured a subset of men at high risk for osteoporosis and fracture those with prostate cancer. As the pilot project demonstrates, a significant proportion (40%) of these patients indeed are at high risk for fracture based on DXA and none of these patients were on approved osteoporosis medications. Unfortunately we only captured 50% of the identified patients, with most refusing to be evaluated given their age or the feeling this did not apply to them. Regardless, this pilot project demonstrates that this specific group of patients is at risk for osteoporosis and there needs to be better awareness to capture these patients and obtain appropriate osteoporosis evaluation and treatment. We plan to develop best practice alerts to identify the patients, risk stratify them with DXA and hopefully prevent future morbidity, mortality and health care expenditures with appropriate medical therapy.
To cite this abstract, please use the following information:
Oppermann, Brian P., Harrington, Thomas M., Ayoub, William; Proactively Contacting Men with Prostate Cancer Treated with Anti-Androgen Medications Improves the Evaluation and Treatment of Osteoporosis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :977