TOPLINE

Despite guidelines on bone protection, more than 40% of patients with metastatic castration-resistant prostate cancer received no bone-modifying agents, a US study found. The use has declined in recent years.

METHODOLOGY

• More than 90% of patients with metastatic castration-resistant prostate cancer have bone metastases that put them at risk for fracture and other skeletal-related events. Current guidelines from the American Society of Clinical Oncology recommend the bone-modifying agents denosumab or zoledronic acid for men with bone metastases. But prior studies have pointed to underuse of the drugs.
• To update the evidence, researchers analyzed patient-level data from the Flatiron Health research database, which contains deidentified information from approximately 280 cancer clinics across the US.
• A total of 14,076 patients diagnosed with metastatic castration-resistant prostate cancer between 2013 and 2024 were included (median age, 75 years). The primary outcome was evidence of bone-modifying agent receipt (an order or administration date) after cancer diagnosis.

TAKEAWAY

• Overall, 7969 patients (56.6%) received bone-modifying agents, while 6107 patients (43.4%) did not. Receipt declined over time, from 57.6% of patients in 2013 to 44.4% in 2024.
• Patients who received bone medications were more likely than those who did not receive treatment to be treated in community practices (87% vs 78%) and to have commercial insurance (80% vs 76%; P < .001).
• Among patients who received treatment, denosumab use decreased from roughly 60% in 2013 to 53% in 2024, while zoledronic acid use increased from 38% to 47% during the same period.
• When patients did receive bone-modifying agents, the median time from cancer diagnosis to treatment initiation was 39 days. Just over 54% received treatment within 30 days.

IN PRACTICE

“In our cohort, 43.4% of patients had no [bone-modifying agent] receipt, and [use] was higher in the mid-study years than later years overall, highlighting a gap between recent recommendations and clinical practice,” the study authors wrote. Given the morbidity and mortality associated with skeletal complications, they concluded, “efforts are urgently needed” to increase bone health awareness and timely use of recommended medications.

SOURCE

The study, led by Zeynep Irem Ozay, MD, Huntsman Cancer Institute, University of Utah, Salt Lake City, was published as a research letter in JAMA Network Open.

LIMITATIONS

Study limitations include potential residual confounding, selection bias, and misclassification. Missing data on bone-modifying agent order or administration may have resulted in underestimation of use. Data on bone mineral density testing and bone metastases were unavailable.

DISCLOSURES

Several co-authors reported having financial relationships with various commercial sources. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.