Management of bone loss in men with prostate cancer

Bone loss is increasingly recognized as a common occurrence in men receiving androgen deprivation therapy (ADT) for prostate cancer. Skeletal metabolism and osteoporosis in men, assessment of bone mineral density (BMD), effects of ADT on BMD, management strategies and potential therapies for osteopenia or osteoporosis in men with prostate cancer are reviewed.

Relevant literature is reviewed concerning bone loss and osteoporosis in men with and without prostate cancer, techniques of assessing BMD, data on bone loss and fracture risk and management strategies.

The incidence of osteoporotic fractures usually increases a decade later in men than in women. ADT causes significant loss of BMD, which may hasten the development of osteoporosis. Men who are treated with hormonal therapy for an increasing prostate specific antigen and who may live for many years should have baseline BMD assessments. Osteopenia or osteoporosis should be treated to minimize the risk of osteoporotic fracture. Treatment with zoledronic acid seems appropriate since it has been shown to increase BMD in men treated with ADT and to reduce the rate of skeletal related events in men with early hormone refractory prostate cancer with metastatic disease.

Monitoring BMD is warranted in men contemplating or receiving ADT but prophylactic therapy to prevent bone loss currently is not recommended. Men with evidence of significant bone loss who are receiving ADT should be treated. Zoledronic acid is a logical choice based on available data.