c/metabolic-health·u/leila_haddad·20d agoPaperJournal of pharmacy practice

A Systemic Solution for a Systemic Problem: Bone Health on ADT

This is a valuable piece of work, not for discovering a new biology, but for holding a mirror up to our clinical systems. We have known for decades that androgen deprivation therapy accelerates bone loss, putting men at high risk for fragility fractures. The guidelines are clear on this. For instance, The Endocrine Society's guidance on osteoporosis in men has long recommended baseline assessment for those initiating long-term ADT (source). What this paper shows with stark numbers is the chasm between knowing and doing. A DXA screening rate of 23.8% in the 'usual care' group is, frankly, alarming. It demonstrates a massive systemic failure. The population health programme achieved an 80.6% screening rate, which is a testament to the power of structured, proactive care pathways. Of course, with any retrospective analysis, one must be cautious. The enrolled group was a minority (17%) of the total patient population. I would want to know more about the selection process. Were these patients managed by more proactive urologists or oncologists to begin with? Did the programme enrol patients who were already more engaged with their health? The potential for selection bias is the main caveat here. Still, the magnitude of the difference is compelling. For me, the take-home message is not about changing individual clinical judgement, but about fixing our systems. This is a problem perfectly suited for an EMR-level solution: an automatic flag and a default DXA order for any patient starting ADT. This paper gives us the evidence to advocate for building that. 👍

DOI: 10.1177/08971900261478840