Preservation of bone health in prostate cancer

Bone is the most common site of metastasis in prostate cancer. The burden of disease from bone metastasis has repercussions in terms of cost to society, decreased quality of life, and decreased survival. Given the magnitude of bone-related morbidity in advanced prostate cancer, physicians need to be aware of preventive and therapeutic measures, and to be proactive in implementing them.

Patients with prostate cancer are often osteopenic at baseline. Implementing androgen-deprivation therapy further increases bone mineral density loss. Lifestyle changes, vitamin D and calcium supplementation may slow the rate of bone mineral density loss. Bisphosphonates reduce androgen-deprivation therapy-related bone loss in prostate cancer patients. Zoledronic acid is the only bisphosphonate proven to decrease skeletal-related events in a randomized controlled trial in patients with metastatic prostate cancer. Newer agents such as selective oestrogen receptor modifiers and antibodies targeting receptor activator of nuclear factor-kappaB ligand are under investigation.

Bone mineral density loss and skeletal complications are directly related to androgen-deprivation therapy and metastases in prostate cancer patients. Preventive and therapeutic modalities are available to physicians, who should be proactive in implementing them. Novel agents are under investigation and data pertaining to their efficacy should become available in the near future.