Approach to the Prostate Cancer Patient with Bone Disease -- Greenspan 93 (1): 2 -- Journal of Clinical Endocrinology & Metabolism

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http://jcem.endojournals.org/cgi/content/abstract/93/1/2

Approach

to the Prostate Cancer Patient with

Bone Disease

L. Greenspan

University

of Pittsburgh School of Medicine, Clinical and Translational Research Center,

Osteoporosis Prevention and Treatment Center, Pittsburgh, Pennsylvania 15213

Address

all correspondence and requests for reprints to: L. Greenspan, M.D.,

University of Pittsburgh School of Medicine, Clinical and Translational

Research Center,

Osteoporosis Prevention and Treatment

Center, 3471 Fifth Avenue, Pittsburgh, Pennsylvania

15213. E-mail: greenspans@....

Prostate

cancer is the most common visceral malignancy in men. Androgen

deprivation therapy (ADT) is commonly used in patients with

nonmetastatic prostate cancer and is associated with significant bone

loss and fractures. The greatest bone loss occurs during initiation

of ADT. Men should have assessment of skeletal integrity with bone

mineral density examination by dual x-ray absorptiometry of the hip

and spine. Men with fragility fractures or osteoporosis by bone

density should be considered for bisphosphonate therapy. Men with

low bone mass may need antiresorptive therapy, depending on other

risk factors. Men with a normal bone mineral density should be

followed up closely with bone densitometry while on ADT. All men

should receive preventive measures with calcium (1200 mg daily in

divided doses), vitamin D (800–1000 IU/d), and weight-bearing

exercise. Men should be evaluated for additional secondary causes of

bone loss including vitamin D insufficiency. Guidelines are needed

for androgen-induced bone loss screening and treatment.