Managing bone loss in men with locally advanced prostate cancer receiving androgen deprivation therapy

Ron S. Israeli, Christopher Ryan, Laura L. Jung

    Research output: Contribution to journalArticle

    45 Citations (Scopus)

    Abstract

    Purpose: We reviewed the pathogenesis, diagnosis, prevalence, prevention and treatment of bone loss in patients with nonmetastatic prostate cancer receiving androgen deprivation therapy. Materials and Methods: Using PubMed® we performed a comprehensive literature search to identify articles on bone mineral density loss in patients with nonmetastatic prostate cancer receiving androgen deprivation therapy. Pertinent articles were reviewed and evaluated. Results: Bone mineral density loss and related fractures were recently established as significant adverse events associated with androgen deprivation therapy. Patients with nonmetastatic prostate cancer receiving androgen deprivation therapy experience annual bone mineral density losses of 0.6% to 4.6% with the most significant loss within year 1 of therapy. In addition to calcium and vitamin D supplements, current treatment options for androgen deprivation therapy induced bone loss include synthetic estrogens, selective estrogen receptor modulators and bisphosphonates. Recent safety concerns have been identified, including renal dysfunction with intravenous bisphosphonates and osteonecrosis of the jaw with oral and intravenous bisphosphonates. However, minimal renal dysfunction and no cases of osteonecrosis of the jaw have been reported in this setting. Conclusions: Because the most significant bone mineral density loss occurs within year 1 of androgen deprivation therapy and most fractures in healthy men occur in those without osteoporosis, early intervention is warranted to prevent skeletal morbidity in patients with nonmetastatic prostate cancer receiving androgen deprivation therapy. Although the majority of and the most compelling evidence supports the use of bisphosphonates for preventing and treating androgen deprivation therapy induced bone loss, further study is needed to define the optimal regimen, timing of initiation and duration of therapy as well as long-term efficacy and safety.

    Original languageEnglish (US)
    Pages (from-to)414-423
    Number of pages10
    JournalJournal of Urology
    Volume179
    Issue number2
    DOIs
    StatePublished - Feb 2008

    Fingerprint

    Androgens
    Prostatic Neoplasms
    Bone and Bones
    Bone Density
    Diphosphonates
    Therapeutics
    Jaw
    Bisphosphonate-Associated Osteonecrosis of the Jaw
    Estradiol Congeners
    Kidney
    Selective Estrogen Receptor Modulators
    Safety
    Osteonecrosis
    PubMed
    Vitamin D
    Osteoporosis
    Calcium
    Morbidity

    Keywords

    • Androgen antagonists
    • Bone and bones
    • Osteoporosis
    • Prostate
    • Prostatic neoplasms

    ASJC Scopus subject areas

    • Urology
    • Medicine(all)

    Cite this

    Managing bone loss in men with locally advanced prostate cancer receiving androgen deprivation therapy. / Israeli, Ron S.; Ryan, Christopher; Jung, Laura L.

    In: Journal of Urology, Vol. 179, No. 2, 02.2008, p. 414-423.

    Research output: Contribution to journalArticle

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