Summary:
Prostate cancer is the most common form of cancer in men in many developed
countries and is the second most frequent cause of tumor mortality in men
population.Many men with locally advanced or high-risk form of non- metastatic
prostate cancer and those with relapsing disease receive androgen deprivation
therapy .
The androgen deprivation therapy increases the risk of metastatic bone fracture
as a result of increased bone turnover and decreased bone density ,in a
time-dependent way.This leads to an increase in the long term fracture relative
risk of 45 % , which is a major side effect because hip fracture in men is
associated with increased mortality.
All patients prior to initiating long-term androgen deprivation therapy should
be subjected to measurement of BMD by the method of Dual-energy X-ray
absorptiometry (DEXA). Simultaneously should be encouraged to adopt changes in
their lifestyle , By proceeding in cessation of smoking, reducing alcohol
consumption and increasing physical activity within a custom exercise program
that includes resistance training .
The decision to initiate treatment should be taken when found an initially low
price BMD ( T-score value less than -2.5 , or less than -1 in the presence of
other risk factors for osteoporosis) . Bisphosphonates have been shown to
increase bone density at the hip and spine in several studies of people under
androgen deprivation therapy for prostate cancer.The human monoclonal antibody
against RANKL denosumab and selective modulators of estrogen receptor (SERM)
toremifene , may be the future in the treatment of the above patients as recent
studies have shown reduction in fracture risk.The treatment duration and
monitoring program of these patients remains unclear and should be determined
with the help of future prospective studies.
Keywords:
Effects on bones, Androgen deprivation, Fractures, Prostate cancer, Bone mineral density
