Bone Health Articles

BERKELEY, CA (UroToday.com) -

Prostate cancer ADT/bone-health clinics – not a common service

There is still a lack of evidence that minodronate or denosumab prevents bone loss due to androgen deprivation therapy (ADT) in non-Western patients. This study showed that both drugs significantly improved lumbar spine and total hip bone mineral density in Asian men with prostate cancer who received ADT.

OBJECTIVE - To investigate the relationship effect of androgen deprivation therapy (ADT) and fracture in men in the UK.

PATIENTS AND METHODS - Using the Hospital Episodes Statistics (HES) database for years 2004 to 2008 that contains all the information about NHS and NHS-funded hospital admissions in England - 8,902 patients were found to have had prostate cancer and an admission to hospital with a fracture in 2004 to 2008.

Bone health education and implementation of preventive measures are key to effective management of osteoporosis. We assessed areas of knowledge deficits with respect to bone health in breast and prostate cancer survivors and the preferred source of health information METHODS: We used a mixed methods approach.

Survivors who have received pelvic radiotherapy make up many of the long-term cancer population, with therapies for gynaecological, bowel, bladder and prostate malignancies.

Prostate cancer survivors face an elevated lifetime risk of fracture due to factors that include older age, bony metastases, and use of androgen deprivation therapy in the curative setting, which increases the risk of osteoporosis and fracture.

More than a third of cancers are diagnosed in people over the age of 75. Androgen deprivation for prostate cancer and aromatase inhibitors in breast cancer accelerate age-related bone loss and increase fracture rates.

Prostate cancer is a substantial worldwide health care challenge. The disease is associated with detrimental effects on bone remodelling, mediated by the RANK/RANK ligand (RANKL) system.

Male osteoporosis is now a well-recognized medical disorder with established clinical guidelines for both diagnosis and management. Prevention as well as management of osteoporosis in men consulting the andrological outpatient clinic because of low testosterone, however, is not well established.

Radium-223 is a bone-seeking, alpha-emitting radionuclide used in metastatic castration-resistant prostate cancer (mCRPC). Radium-223 increases the risk of fracture when used in combination with abiraterone and prednisolone.

The initiation of Androgen Deprivation Therapy (ADT) results in rapid and profound hypogonadism, resulting in significant bone and muscle loss, increasing the risk for osteoporosis (OP), falls, and fractures.

Androgen deprivation therapy for prostate cancer can lead to osteoporosis and increased fracture risk. The Fracture Risk Assessment Tool (FRAX®) questionnaire can be used for risk stratification, and our study has demonstrated that the majority of men (91%) in our cohort commencing ADT for prostate cancer were considered low risk for future osteoporotic fracture.

Management and palliation of pathologic fracture (PFx) secondary to metastatic prostate (mCaP) and renal cancer (mRCa) is hospital resource intensive. Using a national all-payer database, we assessed the burden of PFx secondary to mCaP and mRCa nationwide.

This study aims to evaluate the quality of care (QOC) and use of validated risk algorithms provided in a specialized osteoporosis clinic to men with prostate cancer on androgen deprivation therapy (ADT) who are at risk of bone loss and fragility fractures.

Several ongoing clinical trials are investigating novel therapies and combinations of existing therapies for the treatment of patients with metastatic castration-resistant prostate cancer. One such trial, ERA 223, has shown that the combination of abiraterone plus radium-223 did not improve symptomatic skeletal event-free survival compared with abiraterone plus placebo.