Editorial Comment

Abstract

Osteoporosis or osteopenia is a potential significant and debilitating problem for patients with prostate cancer (CaP) receiving androgen deprivation therapy (ADT). The increasing use of ADT in patients with locally advanced disease in combination with radiation, patients with node positive CaP after prostatectomy, and patients with biochemical recurrence have significantly contributed to a higher incidence of osteoporosis in this population. 1 Saylor P.J. Keating N.L. Smith M.R. Prostate cancer survivorship prevention and treatment of the adverse effects of androgen deprivation therapy. J Gen Intern Med. 2009; 24: 389-394 Crossref Scopus (49) Google Scholar Osteoporosis puts patients at risk for fracture, and with a fracture the mortality rate is 12%-20% after the first year of the event. 2 Mincey B.A. Tan W.W. The management of bone loss in patients with breast or prostate cancer. Support Cancer Ther. 2004; 1: 150-156 Crossref PubMed Google Scholar Over the past few years, urologist, radiation oncologist, medical oncologist have began to recognize this problem and had screened for this side effect. Bisphosphonates had been shown in several studies to improve bone mineral density in patients who are being started on ADT; however, there are limited studies to show any direct effect on the risk of fractures. 3 Smith M.R. McGovern F.J. Zietman A.L. et al. Pamidronate to prevent bone loss during androgen deprivation therapy for prostate cancer. N Engl Med. 2001; 345: 948-955 Crossref PubMed Scopus (655) Google Scholar , 4 Smith M.R. Eastham J. Gleason D.M. et al. Randomized controlled trial of zolendronic acid to prevent bone loss in men receiving androgen deprivation for nonmetastatic prostate cancer. J Urol. 2003; 169: 2008-2012 Abstract Full Text Full Text PDF PubMed Scopus (591) Google Scholar This article highlights the most common problem: patients already on ADT who had severe osteopenia (bone mineral density [BMD]> −2) or osteoporosis and the outcome of these patients when they are treated. These are the highest risk patients who are more prone to develop skeletal events. Several studies have shown that bisphosphonates prevent decline in BMD, and more recently, Rank ligand inhibitors (denosumab) are able to decrease the incidence of fracture in CaP that are on ADT for biochemical recurrence. 5 Smith M.R. Egerdie B. Toriz N.H. et al. Denosumab in men receiving androgen-deprivation therapy for prostate cancer. North Engl Edn Med. 2009; 361: 745-755 Crossref PubMed Scopus (909) Google Scholar Several issues that are brought to the forefront with ADT use include the need to screen for osteoporosis before starting any patient on ADT, need to be monitored for decrease bone loss while on treatment, necessity to treat appropriately when diagnosed with osteoporosis, and the importance of proactively prescribing physical activity and calcium with vitamin D to patients high risk of osteoporosis. The Use of Zoledronic Acid in Men Receiving Androgen Deprivation Therapy for Prostate Cancer With Severe Osteopenia or OsteoporosisUrologyVol. 75Issue 5PreviewTo study the effect of zoledronic acid on patients with pre-existing osteoporosis on androgen deprivation therapy (ADT), who are at highest risk for fracture. Zoledronic acid is a potent bisphosphonate that can prevent osteoporosis in patients with nonmetastatic (M0), prostate cancer (CaP) who are initiating ADT. The effect of zoledronic acid on patients with pre-existing osteoporosis on ADT, who are highest risk for fracture, has not been adequately studied. Full-Text PDF