Changes in bone mineral density in men starting androgen deprivation therapy and the protective role of vitamin D

Alibhai, Shabbir M.H.; Mohamedali, Hassanabbas Z.; Gulamhusein, Husayn; Panju, Abbas H.; Breunis, Henriette; Timilshina, Narhari; Fleshner, Neil; Krahn, Murray; Naglie, Gary; Tannock, Ian F.; Tomlinson, George; Warde, Padraig; Canning, S. Duff; Cheung, Angela M.

doi:10.1007/s00198-013-2343-4

Cited by 41 publications

(41 citation statements)

References 33 publications

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“…(61) Ensuring that patients maintain adequate intakes of calcium and vitamin D also should be added to any comprehensive skeletal health program, although calcium and vitamin D by themselves are insufficient to limit ADT-associated bone loss. (62, 63)…”

Section: Prostate Cancermentioning

confidence: 99%

Osteoporosis and Cancer

Drake

2013

Curr Osteoporos Rep

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Cancer is a major risk factor for bone loss and fractures. This is due both to direct effects of cancer cells on the skeleton and to deleterious effects of cancer-specific therapies on bone cells. Marked improvements in survival for many cancers mean that strategies to limit bone loss and reduce fracture risk must be incorporated into the care plans for nearly all patients with cancer. The vast majority of effort thus far has focused on bone loss in patients with breast and prostate cancers, with comparatively few studies in other malignancies. Anti-resorptive therapies have proven nearly universally effective for limiting bone loss in cancer patients, although few studies have been powered sufficiently to include fractures as primary endpoints, and patients are frequently neither identified nor treated according to published guidelines. Non-pharmacologic approaches to limit falls, particularly in elderly patients, are also likely important adjunctive measures for most cancer patients.

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Section: Prostate Cancermentioning

confidence: 99%

Osteoporosis and Cancer

Drake

2013

Curr Osteoporos Rep

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“…Some studies showed a greater bone loss in the first 6 to 12 months of ADT use, and decline in bone density was much less prominent beyond the first year. 2,9–11 In contrast, a large longitudinal study of 618 men with newly diagnosed advanced PCa showed that those with normal BMD (n = 124) or osteopenia (n = 241) at baseline had declining BMD for up to 7 years with GnRH agonist treatment, even though the latter received daily vitamin D (400 IU) and calcium (500 mg) supplements. 12 Thus, this indicates that the commonly prescribed vitamin D and calcium doses seem to be insufficient to prevent ADT-induced bone loss.…”

Section: Introductionmentioning

confidence: 99%

Effect of Androgen Deprivation Therapy on Bone Mineral Density in a Prostate Cancer Cohort in New Zealand: A Pilot Study

Wang

Karunasinghe

Plank

et al. 2017

Clin Med Insights Oncol

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Introduction:Reduction in bone mineral density (BMD) is a common side effect of androgen deprivation therapy (ADT). We aimed to examine the cross-sectional and longitudinal variation in BMD and associated bone markers in patients with nonmetastatic prostate cancer (PCa) managed with and without ADT.Methods:Bone mineral density of the total body, lumbar spine, femoral neck, ultradistal forearm, and one-third distal radius was measured in 88 patients with PCa without bone metastases at baseline and at 6 months. Patients were categorized into 4 groups: (1) acute ADT (≤6 months), (2) chronic ADT (>6 months), (3) former ADT, and (4) no ADT (controls). Serum levels of bone metabolism markers, procollagen type I N-terminal propeptide (PINP) and C-terminal cross-linking telopeptide of type I collagen (CTX), were also measured.Results:In the cross-sectional analysis, men receiving chronic ADT had significantly lower total body BMD as compared with former ADT users and men with no ADT. In longitudinal analysis, a significant reduction in ultradistal forearm BMD was observed in both acute and chronic ADT users after 6 months (4.08% and 2.7%, P = .012 and .026, respectively). A significant reduction in total body BMD was observed in acute ADT users (2.99%, P = .032). Former ADT users had a significant increase in both lumbar spine and femoral neck BMD (2.84% and 1.59%, P = .008 and .002, respectively). The changes in BMD were not significantly different between acute and chronic ADT users. In the cross-sectional analysis, higher levels of PINP and CTX were observed in acute and chronic ADT users than former ADT users or PCa controls. In longitudinal analysis, the level of serum PINP and CTX did not change significantly from baseline to 6 months in acute, chronic, and former ADT users, or PCa controls, and the percentage change did not differ among the 4 groups.Conclusions:Men on acute ADT had a similar rate of bone loss to men on chronic ADT. Reversibility in ADT-induced bone loss was observed in those who discontinued ADT. Serum levels of PINP and CTX were higher in acute and chronic ADT users and levels returned to the range of PCa controls when treatment was withdrawn.

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“…More recently, in a prospective longitudinal study, Alibhai et al88 examined the long-term effects of calcium and vitamin D supplementation in 160 prostate cancer patients (mean age, 69 years), with and without ADT. Vitamin D, but not calcium, was shown to provide some protection from bone density loss, especially in the first year of ADT.…”

Section: Effect Of Nutrition and Dietary Supplements On The Complicatmentioning

confidence: 99%

Integrating diet and exercise into care of prostate cancer patients on androgen deprivation therapy

Moyad

Newton²,

Tunn

et al. 2016

RRU

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Improved diagnosis and treatment regimens have resulted in greater longevity for men with prostate cancer. This has led to an increase in both androgen deprivation therapy (ADT) use and duration of exposure, and therefore to its associated adverse effects, such as sexual dysfunction, osteoporosis, reduced muscle mass, increased fat mass, and increased incidence of cardiovascular disease and type 2 diabetes. Given that the adverse effects of ADT are systemic, often debilitating, and difficult to treat, efforts continue in the development of new strategies for long-term management of prostate cancer. The PubMed database was searched to select trials, reviews, and meta-analyses in English using such search terms as “prostate cancer” and “androgen deprivation therapy”, “cardiovascular risk”, “lean body mass”, “exercise”, and “diet”. The initial searches produced 379 articles with dates 2005 or more recent. Articles published after 2004 were favored. This review utilizes the latest data to provide a status update on the effects of exercise and diet on patients with prostate cancer, focusing on ADT-associated side effects, and it discusses the evidence for such interventions. Since the evidence of large-scale trials in patients with prostate cancer is missing, and an extrapolation of supporting data to all patient subgroups cannot be provided, individualized risk assessments remain necessary before the initiation of exercise and diet programs. Exercise, diet, and nutritional supplementation interventions have the potential to provide effective, accessible, and relatively inexpensive strategies for mitigating ADT-associated toxicities without introducing additional adverse effects.

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Changes in bone mineral density in men starting androgen deprivation therapy and the protective role of vitamin D

Abstract: Loss of BMD associated with ADT is greatest at the lumbar spine and in the first year. Vitamin D but not calcium may be protective particularly in the first year of ADT use.

Cited by 41 publications

References 33 publications

Osteoporosis and Cancer

Osteoporosis and Cancer

Effect of Androgen Deprivation Therapy on Bone Mineral Density in a Prostate Cancer Cohort in New Zealand: A Pilot Study

Integrating diet and exercise into care of prostate cancer patients on androgen deprivation therapy

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