Approach to the prostate cancer patient with bone disease.
Prostate cancer is the most common visceral malignancy in men. Androgen deprivation therapy (ADT) is commonly used in patients with nonmetastatic prostate cancer and is associated with significant bone loss and fractures. The greatest bone loss occurs during initiation of ADT. Men should have assessment of skeletal integrity with bone mineral density examination by dual x-ray absorptiometry of the hip and spine. Men with fragility fractures or osteoporosis by bone density should be considered for bisphosphonate therapy. Men with low bone mass may need antiresorptive therapy, depending on other risk factors. Men with a normal bone mineral density should be followed up closely with bone densitometry while on ADT. All men should receive preventive measures with calcium (1200 mg daily in divided doses), vitamin D (800-1000 IU/d), and weight-bearing exercise. Men should be evaluated for additional secondary causes of bone loss including vitamin D insufficiency. Guidelines are needed for androgen-induced bone loss screening and treatment.
Greenspan
Susan L
SL
University of Pittsburgh School of Medicine, Clinical and Translational Research Center, Osteoporosis Prevention and Treatment Center, 3471 Fifth Avenue, Pittsburgh, Pennsylvania 15213, USA. greenspans@dom.pitt.edu
D015502:Absorptiometry, Photon; D000368:Aged; D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects / Q000502:physiology; D004164:Diphosphonates / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009376:Neoplasms, Hormone-Dependent / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism; D010024:Osteoporosis / Q000139:chemically induced / Q000209:etiology* / Q000628:therapy; D011471:Prostatic Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism
D000726:Androgen Antagonists; D004164:Diphosphonates