Bone health is an important consideration in men with prostate cancer. Androgen deprivation therapy (ADT) accelerates bone loss and consequently increases fracture risk. Patients given ADT should undergo baseline assessment of risk. Antiresorptive therapy is recommended for all men who have had a fracture, and should be considered for primary prevention among men at high risk.
• Reduced bone mass is highly prevalent in men with prostate cancer, even before initiation of androgen deprivation therapy (ADT).
• ADT accelerates the age-associated decline in bone mineral density (BMD).
• All men should have a baseline assessment of fracture risk before commencing ADT, and regular monitoring during ADT.
• Regular physical activity and adequate calcium and vitamin D intake is recommended for all men.
• Treatment with antiresorptive drugs is recommended for men undergoing ADT with a previous minimal trauma fracture, a vertebral fracture on thoracolumbar spine x-ray, a baseline BMD T-score of -2.0 or less, or a 10-year absolute risk of 20% or more for a major osteoporotic fracture or 3% or more for a hip fracture.
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