Quality improvement initiative to increase osteoporosis screening in patients with prostate cancer on long-term androgen deprivation therapy.

Abstract

51 Background: Long-term androgen deprivation therapy (ADT) for hormone sensitive prostate cancer (HSPC) is associated with increased bone mineral density loss, risk for major osteoporotic fractures and increased morbidity and mortality. Although guidelines recommend baseline bone mineral density (BMD) assessment before starting ADT, national osteoporosis screening rates remain low around 8%. The aim of this quality improvement initiative was to increase osteoporosis screening rates to 20% for HSPC patients on long-term ADT seen at the University of Virginia Cancer Center. Methods: A multidisciplinary team of health care professionals was assembled and completed the ASCO Quality Training Program in 2024. Baseline data on osteoporosis screening among patients with HSPC treated with ADT for longer than 6 months at the University of Virginia Cancer Center between August 2023 and June 2024 was analyzed. After conducting a thorough evaluation of our current osteoporosis screening process, which included a provider survey, process mapping, and a root cause analysis, we implemented two Plan-Do-Study-Act (PDSA) cycles and tracked our outcome measure of completed bone mineral density assessments with a statistical control chart (P-Chart). Results: Between August 2023 and June 2024, an average of 11% of prostate cancer patients underwent BMD assessment with notable screening rate disparities based on the area deprivation index. A provider survey showed agreement in the importance of osteoporosis screening, but providers were hesitant to adopt routine screening protocols. PDSA Cycle 1 involved the standardization of provider practices by implementation of risk-stratified screening criteria. In PDSA Cycle 2, an email notification system was established to alert providers about patients who are eligible and due for osteoporosis screening. Following these interventions, we observed a special cause variation with an increase in the osteoporosis screening rate from 11.4% at baseline to 17.3% (P = 0.001) by July 2025. A review of 63 DEXA scans revealed that 54% of patients were diagnosed with osteopenia and 17.5% with osteoporosis. Barriers to achieving our benchmark for osteoporosis screening included competing clinical priorities, limited time during clinic visits, patient preferences and goals of care. Conclusions: Establishing consensus on risk-stratified osteoporosis screening criteria for HSPC patients on long-term ADT and notification of providers on eligible patients led to increased rates of osteoporosis screening.