AUA 2024: Enhancing Bone Health Screening for Prostate Cancer Patients Starting Androgen Deprivation Therapy: The Auto-Recruit Outpatient System

( The 2024 American Urological Association (AUA) annual meeting held in San Antonio, TX was host to the advanced prostate cancer moderated poster session. Dr. Chiayen Lin presented the results of a retrospective study, focusing on the implementation of an auto-recruitment pop-up alert system aimed at promoting bone health screening among patients initiating androgen deprivation therapy (ADT) for prostate cancer.

Dr. Lin commenced her presentation by outlining the importance of bone health screening before initiating ADT in prostate cancer patients. Despite recommendations in numerous clinical practice guidelines, bone health remains an underestimated and often neglected aspect of prostate cancer management. The study investigated whether integrating a pop-up reminder into their outpatient electronic medical record system could streamline the screening process and enhance bone health surveillance in these patients.

The pop-up reminder appeared each time ADT was prescribed for a prostate cancer patient, provided there had been no dual-energy x-ray absorptiometry (DXA) screening within the preceding year. The pop-up reminder triggered a spinal XR, DXA, total testosterone and the calculation of the FRAX score. While this auto-recruitment system was initiated in 2021, the study retrospectively analyzed data from 2000 to 2018 to assess whether the implementation of this new alert system correlated with increased screening and surveillance of bone health in prostate cancer patients prescribed ADT.

The analysis encompassed 496 patients from 2000 to 2018, prior to the implementation of the auto-recruit outpatient system (non-participants), and 251 patients (participants) from March 2021 to February 2022, when the system was integrated into their medical records. Patient demographics and clinical characteristics are outlined in the table below:


The non-participant group was noted to have older patients, with significantly longer ADT usage and almost three times the number of patients on bone protective agents (20.4% vs. 7.2%). In the participants group, the patients that have used ADT for longer than one year, showed worse T-scores and had a significantly higher rate of osteoporosis versus those who used ADT for less than one year. (34.5% vs. 23.2%)


Before the introduction of the auto-recruit outpatient system, only 9.5% of patients had undergone DXA screening, with merely 1.9% having pre-and-post ADT DXA scans. Following the integration of the auto-recruit outpatient system, 34.3% of patients were scheduled for bone health screening. Notably, 509 patients were already receiving bone protective agents, leading the investigators to consider DXA exams potentially unnecessary in these cases according to Dr. Lin.

The investigators showed that among the patients undergoing bone health screening, 71 individuals (28.3%) were diagnosed with osteoporosis, while 119 (47.4%) were identified as having osteopenia. Additionally, a noteworthy observation was the increase in the percentage of patients taking calcium supplements and bone protective agents. Prior to screening, only 16.3% were taking calcium supplements and 7.2% were on bone protective agents, whereas after screening, these percentages rose to 44.2% and 25.5%, respectively (p<0.001).


Dr. Lin concluded her presentation by saying that bone health screening for patients with prostate cancer who are ADT users is still an unmet need. An automated convenient system that reminds physicians of bone health screening whenever ADT is prescribed can positively influence physician decisions, leading to a notable increase in the bone health screening rate and even boosting the percentage of patients taking calcium supplements and bone protective agents as more patients with osteopenia and osteoporosis are diagnosed through increased screening efforts.

Presented by: Chiayen Lin, MD, Attending Urologist at the Division of Urology, Department of Surgery, VGHTC

Written by: Julian Chavarriaga, MD – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @chavarriagaj on Twitter during the 2024 American Urological Association (AUA) Annual Meeting, San Antonio, TX, Fri, May 3 – Mon, May 6, 2024.