Bone complications of androgen deprivation therapy: screening, prevention, and treatment

Contemporary treatments for prostate cancer have probably contributed to prolonged survival in a significant number of patients. Those under androgen deprivation therapy (ADT) face, however, the danger of increased bone complications that may arise due to compromised bone integrity. Such complications include fractures due to accelerated bone resorption and pathologic fractures due to the metastases that often occur with cancer progression. We herein discuss available strategies to avoid bone loss in this patient population.

Present recommendations to counter the effects of ADT on bone integrity include calcium and vitamin D supplementation. Bisphosphonates are helpful in reducing bone resorption and improving bone mineral density. New agents such as denosumab (a monoclonal antibody against RANK ligand) and selective estrogen receptor modulators seem to hold promise with respect to fracture risk reduction in patients on ADT.

Bone health in patients suffering from prostate cancer is gaining increased attention, especially with active agents reaching maturity in randomized trials. Ultimately, bone preservation should become the concern of every physician caring for patients on ADT.