CUA Online library

Introduction and Objectives: ADT can induce long-term side effects including bone loss. Men receiving ADT have a 5- to 10- fold increased rate of bone loss , and up to 20% fracture risk by 5 years of treatment. , . Guidelines exist for bone loss management in this population but there is evidence of poor adherence. We assessed the knowledge and current practices regarding bone loss management in a sample of Canadian prostate cancer (PC) specialists. Methods: Using Dillman’s tailored design method, a questionnaire was distributed to PC specialists identified through the Canadian Urological Association, the Genito-Urinary Radiation Oncologists of Canada group, and the Canadian Urologic Oncology Group. Results: 156 PC specialists completed the questionnaire. Awareness of recommendations regarding the frequency of repeat DXA scans (76.3%) and vitamin D use (70.3%) was relatively high but lower for calcium intake (53.2%) and amount of weekly exercise (20.7%). A minority were aware of the prevalence of osteoporosis in otherwise healthy 60-year-old males (27.3%), the risk of developing osteoporosis after 1 year of continuous ADT (37.8%), and the excess fracture risk after 5 years on ADT (14.7%). 34.4% of respondents reported routinely ordering bone mineral density (BMD) tests prior to starting ADT and 36.6% ordered routine BMD tests after initiating ADT. Most reported routinely recommending exercise, calcium and supplemental vitamin D. The most significant barriers to implementing the recommendations were lack of time to counsel patients and supporting structures (e.g. patient education). Conclusions: Participants were fairly knowledgeable regarding recommendations for managing bone loss in men on ADT. However, there were gaps in knowledge regarding risk of developing osteoporosis and in practice in surveillance and risk assessment. These findings suggest the need for knowledge translation strategies and tools to address this gap between evidence and clinical practice.