| Abstract: |
Objectives: Androgen-deprivation therapy (ADT) is associated with significant bone loss. Methods for management of patients with ADT-associated bone loss are explored. Methods: Existing and novel therapies were identified and researched through PubMed and published guidelines. Results: Management of ADT-associated bone loss includes calcium and vitamin D supplementation and the implementation of behaviour modification techniques, such as initiation of weight-bearing exercise and smoking cessation. If bone mineral density (BMD) studies reveal significant bone loss, pharmaceutical intervention should be considered. However, because of the relatively low potency of oral bisphosphonates and their associated gastrointestinal adverse events and poor compliance, the more potent intravenous bisphosphonates should be considered. Nitrogen-containing bisphosphonates can effectively prevent bone loss during ADT, and zoledronic acid can actually increase BMD in this setting. These clinical management techniques are supported by international guidelines, including those of the European Association of Urology and the consensus recommendations from international panels of experts. Conclusions: Patients who undergo ADT should be monitored for BMD loss, and pharmaceutical interventions should be considered for patients with osteopenia or osteoporosis. In this setting, BMD is considered an acceptable surrogate end point because of its significant association with the risk of fracture. Pharmacologic intervention should be considered in high-risk individuals. Dietary calcium, vitamin D supplementation, and intravenous bisphosphonates may be needed to prevent bone loss during ADT. Zoledronic acid is the most effective bisphosphonate in this clinical setting. © 2006 European Association of Urology. |
