title: Androgen-deprivation-associated bone disease.
abstract: OBJECTIVE
  Androgen deprivation therapy (ADT) remains a common treatment for prostate cancer, even in the nonmetastatic setting and in scenarios without evidence of efficacy. Increasing attention has focused on its adverse effects, of which bone disease in the form of osteoporosis and fractures has been one of the major concerns. Recently published articles are reviewed, focusing on ADT effects on bone and management of ADT-associated bone disease.
  
  
  RESULTS
  A range of strategies directed at ADT-associated bone disease are available, including antiresorptive agents such as denosumab and bisphosphonates, as well as complementary approaches such as calcium and vitamin D supplementation, exercise regimens, and multifaceted interventions incorporating several approaches. Most interventions used bone mineral density as a surrogate outcome, despite compelling evidence that it inadequately captures fracture risk.
  
  
  CONCLUSIONS
  The antiresorptive agents are clearly able to preserve bone mineral density in men on ADT, whereas other approaches have modest to no benefits. Unfortunately, despite intense research interest in this area, no approach has yet demonstrated a definitive and convincing reduction in clinically relevant fracture outcomes. This emphasizes the importance of restricting the use of ADT to settings in which its benefits are clearly established, in order to limit unnecessary complications.
authors.affiliation: aDivision of Urologic Oncology, Department of Urology, Dow Division of Health Services Research, University of Michigan bVA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System cDepartment of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Ted A
authors.initials: TA
authors.lastname: Skolarus
authors.forename: Megan V
authors.initials: MV
authors.lastname: Caram
authors.forename: Vahakn B
authors.initials: VB
authors.lastname: Shahinian
mesh_terms: D000726:Androgen Antagonists / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002118:Calcium / Q000627:therapeutic use; D000069448:Denosumab; D004164:Diphosphonates / Q000627:therapeutic use; D005081:Exercise Therapy; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000139:chemically induced / Q000628:therapy*; D011471:Prostatic Neoplasms / Q000188:drug therapy*; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D000726:Androgen Antagonists; D061067:Antibodies, Monoclonal, Humanized; D018931:Antineoplastic Agents, Hormonal; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D014807:Vitamin D; D000069448:Denosumab; D002118:Calcium