Management of bone health in men with prostate cancer

Abstract Prostate cancer (PCa) is the second most common cancer in men worldwide and primarily affects older men. Androgen deprivation therapy (ADT) is the mainstay of systemic therapy for this disease. Although ADT is an effective treatment to lower testosterone levels and inhibit PCa cell proliferation, it causes significant adverse effects. This includes, although not limited to, a major impact on bone health to accelerate bone loss and increase the incidence of fractures, which can have a significant negative impact on the quality of life as well as survival. The negative impacts on bone can be mitigated with appropriate nonpharmacologic and pharmacologic therapies. There are now many trials demonstrating the efficacy of bisphosphonate and denosumab treatment to prevent bone loss in this population, although fracture data are more limited. While clinical guidelines exist for the screening and optimal management of men with PCa, many men do not receive bone mineral density examinations to assess fracture risk at the onset of ADT. Further, counseling on nonpharmacologic and pharmacologic therapies to maximize bone health is too often overlooked in the overall care of this patient population. As survival of men with PCa improves with newer therapies, future efforts are crucial to address the treatment gap in care of this growing population.