[InoPro trial: collaboration between urologists and primary care physicians in the treatment of osteoporosis in...

Osteoporosis is more common in elderly men than previously suspected. Prostate cancer patients may have an increased rate of osteopenia and osteoporosis independent of therapy. Osteopenia and fracture risk are accelerated in men receiving androgen deprivation therapy. Nevertheless, little is done by primary care physicians and urologists to diagnose and treat osteoporosis in men.

(1) Assess prostate cancer patients' compliance and adherence to bisphosphonate therapy; (2) Increase awareness for osteoporosis in men diagnosed with prostate cancer among urologists and primary care physicians and to evaluate collaboration between the two disciplines.

We included patients with confirmed diagnosis of prostate cancer who fulfilled one or more of the following criteria: (1) age 70 and above; (2) age 60 and above with androgen deprivation therapy or (3) prior diagnosis of osteopenia and osteoporosis. Qualified patients were referred to DXA bone density test. Patients with osteopenia or osteoporosis, who were naïve to bisphosphonates, received recommendations for oral bisphosphonates. Follow-up lasted 6 months and included 2 office visits to ensure patients' compliance and adherence to recommended therapy.

A total of 28 community-based urologists recruited 180 patients. Of the 180 prostate cancer patients, 87 (48%) had osteoporosis and 93 (52%) osteopenia, all were naïve to bisphosphonates. Of the 180 patients, 153 (85%) patients started treatment with bisphosphonates after inclusion; 147/180 (82%) and 136/180 (76%) patients stayed on bisphosphonates for 3 and 6 months respectively. Primary care physicians adopted recommendations for bisphosphonate in 123/180 (68%).

This study showed high compliance and adherence of prostate cancer patients for bisphosphonate recommendation.