Lifestyle guidelines for managing adverse effects on bone health and body composition in men treated with androgen deprivation therapy for prostate cancer: an update

Abstract

Background:Men treated with androgen deprivation therapy (ADT) for prostate cancer are prone to multiple treatment-induced adverse effects, particularly with regard to a deterioration in bone health and altered body composition including decreased lean tissue mass and increased fat mass. These alterations may partially explain the marked increased risk in osteoporosis, falls, fracture and cardiometabolic risk that has been observed in this population.Methods:A review was conducted that assessed standard clinical guidelines for the management of ADT-induced adverse effects on bone health and body composition in men with prostate cancer.Results:Currently, standard clinical guidelines exist for the management of various bone and metabolic ADT-induced adverse effects in men with prostate cancer. However, an evaluation of the effectiveness of these guidelines into routine practice revealed that men continued to experience increased central adiposity, and, unless pharmacotherapy was instituted, accelerated bone loss and worsening glycaemia occurred.Conclusions:This review discusses the current guidelines and some of the limitations, and proposes new recommendations based on emerging evidence regarding the efficacy of lifestyle interventions, particularly with regard to exercise and nutritional factors, to manage ADT-related adverse effects on bone health and body composition in men with prostate cancer.

Muscle, fat and performance during androgen deprivation for prostate cancer

“…Previous research has indicated that duration of ADT appears to be important when considering lean mass, with losses of up to 2.6-3.2% of total body lean mass occurring within the initial 6-9 months of treatment [195] . Given that around one-third of men in our study had not received ADT for this duration when assessed for this study, it is possible that we may have underestimated the true effects of chronic ADT (≥ six months) on total body and regional lean mass.…”

“…Notably, the rationale for calcium supplementation, and in part vitamin D, predominantly stems from the need to address decreases in areal and volumetric BMD in men treated with ADT [195] , and is beyond the scope of this thesis. The following sections will focus on the safety and potential efficacy of supplementation with vitamin D, calcium and protein in ADT-treated men.…”

“…Given the efficacy of the previously mentioned exercise training and emerging evidence supporting the use of nutritional supplementation to potentially counteract the range of treatment-induced adverse effects in men undergoing ADT, it is therefore plausible that the combination of these interventions may optimise benefit in these men [195] . Notably, calcium and vitamin D supplementation likely play a beneficial role when considering exercise training that elicits bone-related adaptations, however, this section will focus on the potential benefits predominantly on muscle.…”

“…Given the range of treatment-induced adverse effects in men undergoing ADT, investigation of lifestyle interventions, such as nutritional supplementation of vitamin D, calcium and protein, is warranted [195] . Notably, the rationale for calcium supplementation, and in part vitamin D, predominantly stems from the need to address decreases in areal and volumetric BMD in men treated with ADT [195] , and is beyond the scope of this thesis.…”

“…One specific treatment, ADT, is often accompanied by prospective decrements in lean mass and muscle CSA [15][16][17][18][19][20][21] , increased fat mass [17][18][19][20][21][22][23] and reduced muscle strength and functional capacity [25][26][27][28][29][30][31][32][33][34] . While rates of compromise vary between trials, in part due to factors such as ADT duration and patient age, men treated with ADT tend to lose 2.0-3.6% lean mass and gain 11% fat mass per year [195] .…”