Bone Health, Osteoporosis and Prostate Cancer

Osteoporosis is a major side effect in the use of androgen deprivation therapy (ADT, hormone therapy) for prostate cancer.  Men are urged to discuss any potential risks of osteoporosis and bone health in general with their physician.  Primary risk factors include hormone therapy, lack of exercise, vitamin D deficiency, tobacco or alcohol use, thyroid problems, having a thin frame, previous fractures and bone metastases.  Bone density measurements (not to be confused with bone scans for metastatic cancer) are generally obtained by either dual-energy X-ray absorptiometry (DEXA) scans or quantitative computed tomography (QCT) scans usually of the lumbar spine and hip.  QCT is a technique that measures bone mineral density using a standard X-ray computed tomography scanner.  QCT enables spine bone mineral density (BMD) measurements on patients with scoliosis, which cannot usually be measured using DXA scans.  It is reported that for men, while the DEXA scan is the most commonly utilized, it seriously underestimates the degree of osteoporosis.  QCT can avoid the artificially high BMD measurements that can confuse the results from DEXA scans in arthritic patients and patients who suffer from disc space narrowing or spinal degenerative diseases.  Therefore, in the case of men with prostate cancer, some physicians recommend QCT over the more common DEXA scan.  To enhance both muscle and bone density, weight-bearing exercise is essential. Several treatments are available for prostate cancer (pc) patients who have osteoporosis or bone metastases.  These include: a) Zometa® (zolendronate), administered by i.v. drip monthly for pc patients with bone metastases; b) Xgeva® (denosumab), one injection monthly also for pc patients with bone metastases; c) Prolia® (denosumab), administered by injection every 6 months for men with osteoporosis  or pc patients on hormonal therapy at high risk of fracture; and, d) Reclast® (zolendronate), administered by i.v. drip annually in men with osteoporosis.  It is recommended that patients take calcium and vitamin D3 supplements and monitor them regularly by blood tests while taking any of the above-medications. Also a dental checkup is recommended before starting any of the above.  It should also be noted that the greatest benefit from these agents is observed in the first year or two and it is possible to be on them too long when their risks begin to outweigh their benefits.  As always, on-going thorough discussions with your oncologist or urologist regarding osteoporosis, bone health and prostate cancer is a necessity.  Major portions of this article were summarized from the February issue of the Prostate Cancer Research Institute (PCRI) Insights as well as the following linked Wikipedia site.

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