Bone Health in Patients With Prostate Cancer: Monitoring and Diagnosis

Abstract

Objectives Androgen-deprivation therapy (ADT) in men with prostate cancer affects bone metabolism and is associated with a decrease in bone mineral density (BMD). The clinical implications of this bone loss have only recently become apparent, and managing skeletal health is an emerging challenge. Methods Existing and novel methodologies for monitoring and maintaining bone health during ADT were identified and researched through PubMed and published guidelines. Results Bone loss has been documented in clinical trials of ADT. Recent large-scale analyses have revealed that ADT results in cumulative increases in the risk of fractures and fractures some of which result in hospitalisation. Further studies have shown that bone fractures correlate with reduced survival in men with prostate cancer. These results illustrate that bone loss during ADT is clinically meaningful. Consensus guidelines support measuring BMD before initiation of and regularly during ADT. Dual-energy x-ray absorptiometry is the most common method for monitoring BMD in this setting, although there are several investigational methodologies. Patients with low BMD should receive treatment for bone loss to reduce the risk of fractures. Conclusions Losses in BMD during ADT may be substantial and can result in increased fracture risk in some men. Such fractures can impede the patient's mobility and may reduce survival. The goals of BMD testing are to track bone health during ADT and to identify patients who require treatment before BMD loss results in fractures. Maintaining bone health during ADT can provide important benefits to patients and may help to preserve their functional independence.