Recommended Citation
Hussain F, Bhatt P, Daines L, Flejsierowicz M, Wankowski D, Adefisoye JO. Missed Opportunities: Sex Disparities in DEXA Screening Among Cancer Patients Receiving Hormonal Therapy. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Bone health complications are a well-recognized but often under-monitored consequence of androgen deprivation therapy (ADT) and aromatase inhibitor (AI) therapy, which accelerate bone mineral density loss and increase fracture risk. Despite guideline recommendations from NCCN and ASCO for baseline and periodic DEXA screening, adherence remains low across multiple real-world studies. However, institution-specific adherence patterns, particularly potential sex-based disparities remain poorly characterized.
Purpose:
To evaluate adherence to guideline-recommended DEXA screening and assess sex-based differences among patients with non-metastatic breast or prostate cancer receiving hormone therapy within Advocate Health Midwest Wisconsin locations.
Methods:
We conducted a retrospective review of patients diagnosed with stage I–III breast or stage I-IVA prostate cancer treated within Advocate Health Midwest Wisconsin locations between 2019–2023 who received ADT or AI therapy. We excluded metastatic disease and coding inaccuracies. Adherence was defined as documentation of baseline or interval DEXA screening consistent with guideline recommendations. We summarized data using counts and frequencies and tested for associations using the Chi-square test with p < 0.05 considered statistically significant.
Results:
Ninety-two patients met inclusion criteria [45 women (all breast), 47 men (all prostate)]. Baseline screening prior to therapy (48.9% vs 21.3%, p < 0.01), DEXA screening ordered (80.0% vs 30.2%, p < 0.01) and documentation of newly identified osteopenia or osteoporosis after therapy (35.6 vs 15.6%, p = 0.09) was higher in women vs. men.
Conclusion:
Significant disparities exist in adherence to bone density screening guidelines between men and women receiving hormone therapy for cancer. Under-screening among men on ADT may reflect lower awareness of osteoporosis risk, fewer standardized screening workflows, and differences in provider perception of fracture risk. These findings identify a modifiable quality gap and support targeted interventions such as EMR prompts, standardized order sets, and provider education to improve adherence and optimize skeletal outcomes. This represents a readily addressable care gap within oncology survivorship management. Larger datasets and prospective studies are needed to validate these findings and guide institutional quality improvement efforts.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Poster
Open Access
Available to all.
Missed Opportunities: Sex Disparities in DEXA Screening Among Cancer Patients Receiving Hormonal Therapy
Background/Significance:
Bone health complications are a well-recognized but often under-monitored consequence of androgen deprivation therapy (ADT) and aromatase inhibitor (AI) therapy, which accelerate bone mineral density loss and increase fracture risk. Despite guideline recommendations from NCCN and ASCO for baseline and periodic DEXA screening, adherence remains low across multiple real-world studies. However, institution-specific adherence patterns, particularly potential sex-based disparities remain poorly characterized.
Purpose:
To evaluate adherence to guideline-recommended DEXA screening and assess sex-based differences among patients with non-metastatic breast or prostate cancer receiving hormone therapy within Advocate Health Midwest Wisconsin locations.
Methods:
We conducted a retrospective review of patients diagnosed with stage I–III breast or stage I-IVA prostate cancer treated within Advocate Health Midwest Wisconsin locations between 2019–2023 who received ADT or AI therapy. We excluded metastatic disease and coding inaccuracies. Adherence was defined as documentation of baseline or interval DEXA screening consistent with guideline recommendations. We summarized data using counts and frequencies and tested for associations using the Chi-square test with p < 0.05 considered statistically significant.
Results:
Ninety-two patients met inclusion criteria [45 women (all breast), 47 men (all prostate)]. Baseline screening prior to therapy (48.9% vs 21.3%, p < 0.01), DEXA screening ordered (80.0% vs 30.2%, p < 0.01) and documentation of newly identified osteopenia or osteoporosis after therapy (35.6 vs 15.6%, p = 0.09) was higher in women vs. men.
Conclusion:
Significant disparities exist in adherence to bone density screening guidelines between men and women receiving hormone therapy for cancer. Under-screening among men on ADT may reflect lower awareness of osteoporosis risk, fewer standardized screening workflows, and differences in provider perception of fracture risk. These findings identify a modifiable quality gap and support targeted interventions such as EMR prompts, standardized order sets, and provider education to improve adherence and optimize skeletal outcomes. This represents a readily addressable care gap within oncology survivorship management. Larger datasets and prospective studies are needed to validate these findings and guide institutional quality improvement efforts.
Affiliations
Aurora St. Luke’s Medical Center, Aurora UW Medical Group, Aurora Sinai Medical Center