Bone health in the prostate cancer patient receiving androgen deprivation therapy: a review of present and future management options

Abstract

Osteoporosis and bone fractures are frequently overlooked complications of androgen deprivation therapy in men with nonmetastatic prostate cancer. All such patients should have their bone mineral density (BMD) monitored and be offered preventive measures, such as calcium and vitamin D supplementation; patients with low BMD should be offered treatment. Several agents, including bisphosphonates, are available (although this use is currently offlabel), and upcoming treatments, such as denosumab and toremifene, have shown promise in reducing fracture risk in these patients. RésuméL'ostéoporose et les fractures osseuses sont des complications souvent négligées du traitement antiandrogénique chez les hommes atteints d'un cancer de la prostate non métastatique. La teneur minérale des os de ces patients devrait être surveillée, et des mesures préventives, comme la prise de suppléments de calcium et de vitamine D, devraient être offertes. Les patients présentant une faible teneur minérale des os devraient se voir offrir un traitement approprié. Plusieurs agents, y compris des bisphosphonates, sont offerts sur le marché (quoique cette indication ne soit pas officiellement approuvée à l'heure actuelle), et des traitements en cours d'étude, comme le dénosumab et le torémifène, se sont révélés prometteurs dans la réduction du risque de fracture chez ces patients.

Utilization of bone densitometry for prediction and administration of bisphosphonates to prevent osteoporosis in patients with prostate cancer without bone metastases receiving antiandrogen therapy

“…However, due to lack of patient adherence, oral bisphosphonates have not been the preferred treatment over intravenous bisphosphonates in this patient population, so likely did not significantly affect the outcome. 14 , 15 …”

“…Oral bisphosphonates are generally poorly absorbed and have gastrointestinal side effects, leading to low patient adherence with these drugs. 14 , 15 Due to lack of adherence, intravenous bisphosphonates are preferred to oral bisphosphonates in this patient population. Oral bisphosphonate use was not captured because the Medicare database does not collect details of oral therapy.…”

Self-reported exercise and bone mineral density in prostate cancer patients receiving androgen deprivation therapy

“…The goal of ADT is chemical castration by decreasing testosterone levels below 50 ng/mL to suppress cancer tumor growth (Ellsworth & Caldamone, ). In turn, the lack of testosterone impairs the cellular replication of new osteoblasts, decreasing BMD and increasing the risk for osteoporosis and bone fracture (Egerdie & Saad, ).…”

Bone-targeted therapy in prostate cancer

“…In the setting of non-metastatic prostate cancer, bisphosphonates have consistently been found to reduce BMD loss associated with ADT in multiple randomized controlled trials, but none have had sufficient power or duration to demonstrate a reduction in fractures [5] …”