Bone Health in Prostate Cancer Survivors: Recent Lessons and Opportunities for Improvement

Prostate cancer survivors have a higher risk of fracture in comparison to the general population. A primary reason is age: most men with prostate cancer are diagnosed at age >65 yr. Although osteoporosis is commonly considered a disease of elderly women, men older than 60 yr have a lifetime risk of fracture of 25% [1]. In a study of 618 men with newly diagnosed prostate cancer, 41% already had osteoporosis, 39% had osteopenia, and only 20% had normal bone mineral density (BMD) [2].

Prostate cancer treatments can further increase the risk of fracture. Androgen deprivation therapy (ADT) worsens bone health, even when given in short courses. Within the first year of ADT treatment, BMD decreases by approximately 2% at the hip and 3% at the lumbar spine and is associated with a 10–20% risk of significant fracture at 5 yr [3], [4]. ADT is increasingly being used in the curative setting, either concurrently with up-front radiation therapy in patients with unfavorable intermediate-risk and high-risk disease, or after radical prostatectomy along with radiation therapy, when high-risk features are seen, or as salvage therapy. This review discusses management of fracture risk among prostate cancer survivors who have received treatments with curative intent and highlights promising strategies for future intervention. We do not discuss bone health management for individuals with metastatic prostate cancer receiving active therapy, for whom there is good evidence of routine antiresorptive therapy.

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