Androgen deprivation therapy and osteoporosis
J Gen Intern Med. 2007 Jul 17 [Epub ahead of print]. Osteoporosis Management in Prostate Cancer Patients Treated with Androgen Deprivation Therapy, Yee EF and others. PMID: 17634780. In January I posted an Update with an explanation of androgen deprivation therapy (ADT) that is used in prostate cancer patients. I pointed out that just calcium or vitamin D therapy are inadequate to prevent or treat osteoporosis for men taking ADT. One of the bisphosphonates, such as Fosamax (alendronate) or Actonel (risedronate) will be needed for adequate prevention of bone loss. And one study showed that intravenous zoledronic acid was effective in also building bone mineral density (BMD)--not just preventing bone breakdown--during ADT therapy. This study by Yee and others now shows how important it is for men on ADT to assure they are getting proper diagnosis and treatment to prevent a loss of BMD when ADT is prescribed to treat their prostate cancer. Just 34% of patients received recommended osteoporosis management based on DXA scans, treatment with bisphosphonates, calcitonin, calcium or vitamin D. Note that neither calcium by itself or in combination with vitamin D is adequate therapy to prevent or treat osteoporosis. So, although these two medications were included in the list of prescribed therapies, they shouldn't have been. The authors conclude: "Most men treated with ADT for prostate cancer did not receive osteoporosis screening, prevention or treatment." Editor's comments: The Yee and others study enrolled patients as of 2005, so it is a very recent study. The bottom line is that men with prostate cancer going on ADT therapy must demand proper diagnostic, preventive, and treatment therapy for osteoporosis. Therapy for the prostate cancer is demanding enough of your time and energy as a patient. You don't want to be dealing with totally unnecessary osteoporosis therapy or a bone fracture at the same time since proven preventive and treatment modalities exist.