Men's Osteoporosis Support Group

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Managing decreased bone density when on androgen deprivation therapy

BJU Int. 2008 Oct 24. [Epub ahead of print], Management of decreased bone mineral density in men starting androgen-deprivation therapy for prostate cancer. Panju AH and others. PMID: 19007370. Androgen deprivation therapy (ADT) for prostate cancer can have serious side effects on bone mineral density (BMD). This study examined whether men starting ADT were prescribed lifestyle and pharmacological interventions for low bone mineral density (BMD). It included sixty-six men (mean age 70.6 years) with non-metastatic prostate cancer starting continuous ADT. It involved patient interviews at the start of ADT, and 3 and 6 months later to obtain their medical histories, and charts were reviewed to determine whether clinicians documented potential bone side-effects in clinic notes, and made lifestyle and/or medication recommendations. Dual-energy X-ray absorptiometry (DXA) was done to determine BMD. At 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. 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. The authors concluded: "A 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."

Editor's comments. ADT is very commonly linked to osteoporosis, thus increasing fracture risk, which can lead to pain, complications and early death. There appears to be about a 15% chance that you will get guidance regarding your need to take preventive measures to retain or increase your BMD when you start ADT. This means men have to educate themselves as to the risks/rewards of ADT and assure that their care providers give them optimal care, not only for the prostate cancer, but for their bone health.

There are other articles on this Website on this topic, including another regarding other side effects of ADT in a 2008 Update. A 2007 Update has a review of the entire topic of ADT for prostate cancer.

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