Management of decreased bone mineral density in men starting androgen‐deprivation therapy for prostate cancer

Abstract

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 sideeffects 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. RESULTSAt 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. CONCLUSIONSA 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. KEYWORDSandrogen-deprivation therapy, bone mineral density, osteoporosis, prostatic neoplasms, quality of care, side-effects Study Type -Therapy (case series) Level of Evidence 4 OBJECTIVETo 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. PATIENTS AND METHODSSixty-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 INTRODUCTION

Physical Exercise for Secondary Osteoporosis

“…[21,81,85,92]). Despite the recommendations for exercise, in a recent observational study, only 7 of 66 (11%) patients undergoing ADT reported discussing lifestyle changes, including exercise, with their physician [93], a finding that contradicts other reports that urologists and radiation oncologists report discussing such lifestyle interventions with ADT-treated patients a majority (~60-80%) of the time [94]. The profound effect of hormone therapy on bone health in prostate cancer patients suggests that more studies should examine exercise as a bone preservation intervention in this population.…”

Preventing Bone Complications in Advanced Prostate Cancer

“…Smoking cessation, moderate caffeine and alcohol intake, and regular weight-bearing exercise, if permitted, are advocated. Simple measures to prevent falls, such as adapting the furniture at home and avoiding rugs, should be considered 40 . More importantly, calcium and vitamin D supplementation should be instituted at the initiation of adt 41 .…”

Quality of care provided to prostate cancer (PC) patients for prevention and treatment of osteoporosis induced by androgen deprivation therapy (ADT)

“…Importantly, more than 70 % of men with prostate cancer are older than 65 and already at risk for osteoporosis or fragility fracture [13]. Indeed, several studies have found that 20-40 % of men with prostate cancer have osteoporosis prior to starting ADT [12,14,15]. In general, osteoporosis is often under-diagnosed, under-prevented, and under-treated in men, even though one in every five 50-year-old men will suffer an osteoporotic fracture during their lifetime and 30 % of all hip fractures occur in men [16].…”