title: Management of decreased bone mineral density in men starting androgen-deprivation therapy for prostate cancer.
abstract: OBJECTIVE
  To determine whether clinicians discuss bone-specific side-effects with patients on androgen-deprivation therapy (ADT) for prostate cancer, or prescribe lifestyle and pharmacological interventions for low bone mineral density (BMD), as decreased BMD is a common side-effect of ADT, leading to increased risk of fracture.
  
  
  METHODS
  Sixty-six men (mean age 70.6 years) with non-metastatic prostate cancer and starting continuous ADT were enrolled in a prospective longitudinal study. BMD was determined by dual X-ray absorptiometry (DXA) at baseline. Patients were interviewed to obtain their medical histories, and charts were reviewed to determine whether clinicians documented potential bone side-effects in clinic notes, and made lifestyle and/or medication recommendations. Both were done at the start of ADT, and 3 and 6 months later. Patients were classified based on DXA T-score as having normal BMD, as osteopenic, or osteoporotic.
  
  
  RESULTS
  At baseline, 53% of patients had osteopenia and 5% had osteoporosis. Within 6 months of starting ADT, general side-effects and bone-specific side-effects of ADT were documented as being discussed with 26% and 15%, respectively. Clinicians recommended lifestyle interventions to 11% of patients. Pharmacological interventions (calcium, vitamin D, and/or bisphosphonates) were recommended to 18% of all patients within 6 months of starting ADT, and to 26% and 67% of osteopenic and osteoporotic patients, respectively.
  
  
  CONCLUSIONS
  A minority of patients is being informed of bone-specific side-effects of ADT. Lifestyle and drug interventions to prevent declines in BMD were recommended uncommonly. Practices around bone health for men starting ADT are suboptimal.
authors.affiliation: Department of Medicine, University Health Network, Toronto, Ontario, Canada.
authors.forename: Abbas H
authors.initials: AH
authors.lastname: Panju
authors.forename: Henriette
authors.initials: H
authors.lastname: Breunis
authors.forename: Angela M
authors.initials: AM
authors.lastname: Cheung
authors.forename: Marc
authors.initials: M
authors.lastname: Leach
authors.forename: Neil
authors.initials: N
authors.lastname: Fleshner
authors.forename: Padraig
authors.initials: P
authors.lastname: Warde
authors.forename: Sarah
authors.initials: S
authors.lastname: Duff-Canning
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
authors.forename: Gary
authors.initials: G
authors.lastname: Naglie
authors.forename: Ian
authors.initials: I
authors.lastname: Tannock
authors.forename: George
authors.initials: G
authors.lastname: Tomlinson
authors.forename: Shabbir M H
authors.initials: SM
authors.lastname: Alibhai
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001851:Bone Diseases, Metabolic / Q000517:prevention & control*; D002118:Calcium / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use*; D004812:Epidemiologic Methods; D050723:Fractures, Bone / Q000517:prevention & control; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000150:complications / Q000188:drug therapy*; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D000726:Androgen Antagonists; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D014807:Vitamin D; D002118:Calcium