Purpose: Describe the prevalence of bone density loss and risk factors for osteoporosis in Veterans seen in a Cancer Survivorship Clinic. Assess the value of identified risk factors in predicting abnormal bone density.
Background: Cancer survivors are at risk for bone density loss secondary to side effects of cancer treatment. The prevalence of osteoporosis is not well defined in this patient population and guidelines regarding screening for osteoporosis, particularly in men, are sparse.
Methods: Veterans seen in the VA Puget Sound Cancer Survivorship Clinic are screened routinely for risk factors for bone density loss as identified in medical literature including medications, treatment sequelae and other factors. Demographics, medical history and DEXA scan results were abstracted from CPRS.
Results: There were 226 Cancer Survivorship Clinic visits between 2/27/15 and 5/18/18. The average age was 64.7 (range 28-87 years) and 91% were male. The most common cancer site was lung (28%), followed by head and neck (18%), prostate (15%), and colorectal (11%).
Thirty-five (15%) Veterans had a prior DEXA scan and 21 (9%) had a diagnosis of osteopenia or osteoporosis. Risk factors for bone density loss were identified for 77 Veterans (34%) and DEXA scans were recommended. DEXA scans ordered by the survivorship nurse practitioner had a higher
rate of completion than when recommended to the primary care provider, 23 of 36 (64%) were completed versus 7 of 42 (17%).
Among the 29 Veterans for whom a DEXA was completed, 13 (43%) had normal bone density, 14 (47%) had osteopenia, and 3 (10%) had osteoporosis.
Risk factors most strongly associated with a finding of decreased bone density were low body weight (100%), chemotherapy (67%), and radiographic osteopenia (67%). Height loss (50%) and hypogonadism (50%) were also associated with abnormal findings.
Implications: At least 17% of Veterans seen in Cancer Survivorship Clinic had abnormal bone density. This number likely is an underestimation as DEXA scans were not completed for half of those with risk factors for osteoporosis. Using specific chemotherapy exposures, radiographic osteopenia, hypogonadism, steroids and self-reported height loss as risk factors appears to be reasonable. Ordering the DEXA scan as part of the survivorship visit may increase compliance.
