The Increasing Responsibility of the Urologist in Maintaining Bone Health in Prostate Cancer Patients

Abstract

Objectives Many men with prostate cancer are osteoporotic or osteopenic before the initiation of androgen deprivation therapy (ADT). Furthermore, they may develop decreased bone mineral density (BMD) and associated increased risks of skeletal complications during therapy. This review provides urologists with information to address bone health issues in men with prostate cancer. Methods Guidelines and therapies were identified and researched through PubMed. Results Studies report clinically significant changes in BMD after 12 months of ADT, and after 5 to 7 years there is a substantially increased risk of fracture. An algorithm for the assessment of BMD, treatment of osteoporosis, and prevention of fractures in patients with prostate cancer has been developed. BMD assessments before ADT is initiated and annually thereafter are recommended. Bisphosphonates effectively preserve BMD in this setting. Zoledronic acid not only prevented bone loss, but produced an increase from baseline BMD at one year in the lumbar spine, femoral neck, trochanter, and hip. Conclusions Maintaining bone health in men with prostate cancer may be an important part of overall disease management. Indeed, proactive intervention with an intravenous bisphosphonate such as pamidronate or zoledronic acid may prevent bone loss and improve BMD in these patients.