Standardized Bone Health Assessment and Treatment Among Prostate Cancer Patients on Androgen Deprivation Therapy in a Large Integrated Managed Care Delivery System

Background: Bone-health risk assessment and treatment among prostate-cancer patients on androgen-deprivation therapy (ADT) is often inadequately completed in clinical practice. Objective: To determine the impact of a population-management program on bone-health risk assessment and bisphosphonate therapy among prostate-cancer patients on ADT. Methods: We used retrospective data from a large integrated healthcare system to identify men aged 41-89 years diagnosed with prostate cancer in 2011-2024 who received ≥1 ADT dose. We compared adherence to internal guideline-recommended bone mineral density (BMD) testing, laboratory evaluation, and bisphosphonate prescriptions at baseline and during follow-up between men enrolled in the population-health program with men and men who were not enrolled (non-enrolled). Results: Among the 9934 eligible patients, 1680 (17%) were enrolled in the program and 8254 (83%) were non-enrolled. The proportion of enrolled patients completing BMD scans within 1 year before or after ADT initiation (80.6%) was substantially higher than among non-enrolled patients (23.8%, P < 0.0001). More enrolled patients were treated with antiresorptive therapy (26.4%) than among non-enrolled patients (14.1%, P < 0.0001). Overall, enrollees were more likely to have ever received any guideline-indicated intervention (78.7% vs 27.8%, P < 0.0001). The average coverage percentage for BMD screening was 24.4% among non-enrolled patients vs 81.1% among enrolled patients ( P < 0.0001). Among antiresorptive-treatment-eligible patients, the average coverage percentage for bisphosphonate therapy was 35.5% among non-enrolled patients compared with 46.1% among enrolled patients ( P < 0.0001). Conclusion: The population-management program significantly outperformed usual care in adherence to BMD testing, laboratory evaluation, and indicated antiresorptive osteoporosis-medication treatment among men with prostate cancer on ADT.