Bone Health and Use of Adjunctive Agents

65 Bone Health and Use of Adjunctive Agents

Jesus H. Hermosillo-Rodriguez and Nicholas Mitsiades

An important issue in patients with prostate cancer is bone health, since both prostate cancer and its therapy can affect the bone. Typically, metastatic lesions from prostate cancer are osteoblastic. However, there is usually a significant osteolytic component, and pathologic fractures can occur. Osteopenia and osteoporosis are also frequent among patients on androgen deprivation therapy (ADT), which also contributes to the incidence of fractures. In this chapter, we focus on adjunct therapies for bone health for patients with prostate cancer.

ADJUNCT THERAPY FOR ADT-RELATED BONE DEMINERALIZATION

ADT increases the risk of osteopenia and osteoporosis and the risk of fractures (1). Patients may also have other risk factors such as smoking, alcohol abuse, caffeine consumption, low vitamin D level, and corticosteroid use. Usual recommendations for prevention and management include:

• Calcium/Vitamin D intake of 1,000 to 1,200 mg/800 to 1,000 IU daily. Vitamin D levels can also be measured and replaced if low.

• Weight-bearing exercise.

• Smoking cessation and limit alcohol consumption.

• Osteoclast inhibition: The timing to initiate osteoclast inhibition is unclear, but most follow the recommendations for the timing of therapy initiation and dosing similar to the management of osteoporosis. Besides bisphosphonates, denosumab can also be used in this setting (see Table 10.1) (1,2).

• History of hip or vertebral fracture.

• T-score ≤2.5 at the femoral neck or spine by dual energy x-ray absorptiometry.

• T-score between −1 and −2.5 at the femoral neck or spine and a 10-year probability of hip fracture ≥3% or 10-year probability of any major osteoporosis-related fracture of ≥20%.

66Table 10.1 Treatment Options for ADT-Related Osteoporosis