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Asian Journal of Andrology (2012) 14, 670–675; doi:10.1038/aja.2012.70; published online 20 August 2012
Skeletal complications of ADT: disease burden and treatment options
Jacques Planas Morin and Juan Morote Robles
Department of Urology, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona 08035, Spain
Correspondence: Dr JP Morin, (jplanas@vhebron.net)
Received 17 February 2012; Revised 15 May 2012; Accepted 4 June 2012
Advance online publication 20 August 2012.
| Abstract |
Therapy based on androgenic deprivation is one of the standard treatments that many prostate cancer patients receive. Moreover, its use is increasing owing to a clear expansion of the indications for this therapy in patients with localized prostate cancer. Despite classically being considered to be well tolerated, androgenic deprivation has adverse effects. Of these, the loss of mineral bone mass is particularly notable and can lead to osteoporosis, as well as an increased risk of bone fracture. Some fractures, such as hip fractures, may have serious consequences. Useful procedures such as bone densitometry can aid in the diagnosis of these conditions. Once diagnosed, decreases in mineral bone mass can be managed by dietary recommendations, general changes in lifestyle or medication. We review the most important randomized controlled trials evaluating different drugs (bisphosphonates, denosumab and toremifene) in the prevention of bone loss and in the reduction in fracture risk in prostate cancer patients treated with androgen-deprivation therapy. Following the applicable recommendations, urologists must carefully monitor the bone health of prostate cancer patients subjected to androgenic deprivation to obtain an early diagnosis and apply the appropriate general and/or therapeutic measures if necessary.
Keywords: androgen deprivation therapy; bisphosphonates; bone fracture; bone mass loss; calcium intake; osteoclast; osteoporosis; prostate cancer |
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