Bone loss in prostate cancer: evaluation, treatment and prevention

Modern medicine offers multiple treatment options to prolong the survival of patients with prostate cancer. However, in the absence of adequate supportive care, the systemic effects of prostate cancer and therapies such as androgen deprivation therapy (ADT) can undermine skeletal integrity, resulting in skeletal complications. Skeletal morbidity contributes to the erosion in quality of life in patients with prostate cancer. These patients are at risk for fractures from cancer treatment-induced bone loss and, later on, pathologic fractures from bone metastases, which may occur during the progression of prostate cancer. Several supportive care options are available to prevent generalized and focal bone loss, including calcium and vitamin D supplements and bisphosphonates. Oral calcium and vitamin D supplementation alone, however, appears to be insufficient to prevent bone loss during ADT. Bisphosphonates may be beneficial in preventing bone loss and eventually reducing skeletal morbidity due to prostate cancer and ADT.