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02-06-2013 | Metabolism | Article

Primary care physicians boost prostate cancer BMD monitoring


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medwireNews: A US study has found that rates of bone mineral density (BMD) testing in men with prostate cancer receiving androgen deprivation therapy (ADT) are highest among those whose primary care physician is involved in their care.

However, while rates of testing increased rapidly over the 12-year study period, absolute rates remain low.

"Our findings support the need to find ways to ensure that [primary care physicians] are adequately involved in the care of men with prostate cancer receiving ADT," say the authors, Vahakn Shahinian (University of Michigan, Ann Arbor) and Yong-Fang Kuo (University of Texas Medical Branch, Galveston).

"This may not only help improve management of bone disease, but also other adverse effects of ADT such as cardiovascular disease, diabetes mellitus and hyperlipidemia, which may all be most appropriately addressed by [primary care physicians]," they add.

The study included 84,036 men with prostate cancer who initiated ADT between 1996 and 2008. Rates of BMD testing within 12 months prior and 3 months after ADT initiation were close to zero prior to 2002, after which point rates sharply rose among men receiving ADT. By 2008, the rate of baseline BMD testing was 11.5% in men initiating ADT, 4.4% in men with prostate cancer not receiving ADT, and 3.8% in noncancer controls.

A similar trend was seen for follow-up BMD testing up to 18 months after initiation of ADT, which plateaued at around 11% in ADT-treated patients from 2005 onwards.

"The divergence from rates of BMD testing in prostate cancer controls not receiving ADT or from non-cancer controls implies specific attention to concerns about bone disease related to ADT raised by studies in the late 1990s and later," comment the authors.

The majority (51.3%) of baseline BMD tests were ordered by primary care physicians, while only 17.9% were ordered by urologists, and 11.3% by oncologists. And, regression analysis showed that patients treated by a urologist alone were 29% less likely to receive a baseline BMD test than those treated by a urologist and a primary care physician.

Writing in the Journal of General Internal Medicine, the authors say that this finding is "perhaps not surprising, as bone health does not fall under the usual purview of urologic care, and many urologists may not feel comfortable diagnosing and managing osteoporosis."

Their results support the use of shared care plans between primary care physicians and cancer specialists, as proposed by the US Institute of Medicine, they conclude.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Kirsty Oswald, medwireNews Reporter

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