Dual-energy x-ray absorptiometry assessment of bone health in Australian men with prostate cancer commencing androgen deprivation therapy

Objective: To determine the prevalence in Australia of bone health assessment of men with prostate cancer by dual-energy x-ray absorptiometry (DXA), from six months before to twelve months after initiation of androgen deprivation therapy (ADT). Design, setting: Cross-sectional national study; linkage of de-identified Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data. Participants: Men (18 years or older) first dispensed PBS-subsidised ADT during 1 May 2017 – 31 July 2020. Main outcome measures: Prevalence of MBS-subsidised DXA assessments undertaken from six months before to twelve months after first ADT prescription. Results: Of 33 836 men with prostate cancer commencing ADT therapy during 2017–20, 6683 (19.8%) underwent DXA bone heath assessments between six months before and twelve months after commencing ADT; the mean time from first ADT dispensing to DXA scanning was +90 days (standard deviation, 134 days). The proportion of men aged 54 years or younger who had scans (66 of 639, 10%) was smaller than that of men aged 70–84 years (4528 of 19 378, 23.4%; adjusted odds ratio, 0.36; 95% CI, 0.28–0.47). Conclusions: For about 80% of men with prostate cancer commencing ADT in Australia, therapy initiation was not accompanied by DXA assessment of bone health. Given the excellent long term prognosis for men with prostate cancer and the availability of bone protective therapy, bone health monitoring should be a routine component of prostate cancer care for men receiving ADT.