The role of bisphosphonates in preventing skeletal complications of hormonal therapy.

Androgen deprivation therapy (ADT) is associated with a significant decrease in bone mineral density (BMD), and continued exposure seems to increase the risk of osteoporotic fracture in men who have prostate cancer treated with this strategy. Men who have prostate cancer may have low BMD before initiation of ADT. Bisphosphonates are pyrophosphate analogs that decrease bone resorption primarily through direct inhibition of osteoclast activity and proliferation. Several bisphosphonates have been evaluated in randomized clinical trials, and the cumulative data show that these medications increase or maintain BMD in men receiving ADT for prostate cancer. The effect on clinical fractures has not been assessed adequately, but bisphosphonates offer an important potential treatment modality to reduce the risk of osteoporotic fracture in this population of men.