Ted A Skolarus1, Megan V Caram, Vahakn B Shahinian. 1. aDivision of Urologic Oncology, Department of Urology, Dow Division of Health Services Research, University of Michigan bVA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System cDepartment of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Abstract
PURPOSE OF REVIEW: Androgen deprivation therapy (ADT) remains a common treatment for prostate cancer, even in the nonmetastatic setting and in scenarios without evidence of efficacy. Increasing attention has focused on its adverse effects, of which bone disease in the form of osteoporosis and fractures has been one of the major concerns. Recently published articles are reviewed, focusing on ADT effects on bone and management of ADT-associated bone disease. RECENT FINDINGS: A range of strategies directed at ADT-associated bone disease are available, including antiresorptive agents such as denosumab and bisphosphonates, as well as complementary approaches such as calcium and vitamin D supplementation, exercise regimens, and multifaceted interventions incorporating several approaches. Most interventions used bone mineral density as a surrogate outcome, despite compelling evidence that it inadequately captures fracture risk. SUMMARY: The antiresorptive agents are clearly able to preserve bone mineral density in men on ADT, whereas other approaches have modest to no benefits. Unfortunately, despite intense research interest in this area, no approach has yet demonstrated a definitive and convincing reduction in clinically relevant fracture outcomes. This emphasizes the importance of restricting the use of ADT to settings in which its benefits are clearly established, in order to limit unnecessary complications.
PURPOSE OF REVIEW: Androgen deprivation therapy (ADT) remains a common treatment for prostate cancer, even in the nonmetastatic setting and in scenarios without evidence of efficacy. Increasing attention has focused on its adverse effects, of which bone disease in the form of osteoporosis and fractures has been one of the major concerns. Recently published articles are reviewed, focusing on ADT effects on bone and management of ADT-associated bone disease. RECENT FINDINGS: A range of strategies directed at ADT-associated bone disease are available, including antiresorptive agents such as denosumab and bisphosphonates, as well as complementary approaches such as calcium and vitamin D supplementation, exercise regimens, and multifaceted interventions incorporating several approaches. Most interventions used bone mineral density as a surrogate outcome, despite compelling evidence that it inadequately captures fracture risk. SUMMARY: The antiresorptive agents are clearly able to preserve bone mineral density in men on ADT, whereas other approaches have modest to no benefits. Unfortunately, despite intense research interest in this area, no approach has yet demonstrated a definitive and convincing reduction in clinically relevant fracture outcomes. This emphasizes the importance of restricting the use of ADT to settings in which its benefits are clearly established, in order to limit unnecessary complications.
Authors: Peter S Kirk; Tudor Borza; Vahakn B Shahinian; Megan E V Caram; Danil V Makarov; Jeremy B Shelton; John T Leppert; Ryan M Blake; Jennifer A Davis; Brent K Hollenbeck; Anne Sales; Ted A Skolarus Journal: BJU Int Date: 2017-11-28 Impact factor: 5.588
Authors: J E Brown; S L Wood; C Confavreux; M Abe; K Weilbaecher; P Hadji; R W Johnson; J A Rhoades; C M Edwards; P I Croucher; P Juarez; S El Badri; G Ariaspinilla; S D'Oronzo; T A Guise; C Van Poznak Journal: J Bone Oncol Date: 2021-06-11 Impact factor: 4.072