Effects of Medical Treatment of Prostate Cancer on Bone Health. (March 2021)

• Record Type: Journal Article
• Authors: Formenti, Anna Maria; Dalla Volta, Alberto; di Filippo, Luigi; Berruti, Alfredo; Giustina, Andrea
• Is Part Of: Trends in endocrinology and metabolism. Volume 32:Number 3(2021)
• Page Start: 135
• Page End: 158
• Publication Date: 2021-03
• Subjects: prostate cancer -- bone mineral density -- fractures -- androgen deprivation -- glucocorticoids; Endocrinology -- Periodicals; Metabolism -- Periodicals; Metabolism; 616.4
• DOI: 10.1016/j.tem.2020.12.004
• Languages: English
• ISSNs: 1043-2760

Abstract

Abstract : Medical treatment of prostate cancer (PC) is multidisciplinary, resulting in prolonged survival. Androgen-deprivation therapy (ADT) can have negative effects on skeletal metabolism, particularly if combined with glucocorticoids. We discuss the pathophysiology and effects of ADT and glucocorticoids on skeletal endpoints, as well as the awareness and management of bone fragility. Coadministration of glucocorticoids is necessary with abiraterone because this causes a novel acquired form of 17-hydroxylase deficiency and synergistically increases the risk of fracture by affecting bone quality. Bone antiresorptive agents [selective estrogen receptor modulators (SERMS), bisphosphonates, and denosumab] increase bone mineral density (BMD) and in some instances reduce fracture risk in PC patients on ADT. Awareness and management of bone health in PC can be improved by integrating endocrinologists into the multidisciplinary PC team. Highlights: Bone health is a relevant clinical concern that is still underestimated in patients medically treated for PC because of their prolonged survival and emerging potentially bone-threatening treatments. The combination of drug-induced hypogonadism and glucocorticoid excess synergistically impairs osteoblast function, causing qualitative bone damage and increased fracture risk. BMD is a poor predictor of fractures in medically treated PC patients, and other measures as trabecular bone score, vertebral morphometry, and body composition are important adjunctive tools to assess fracture risk. Awareness of bone health in PC patients must be improved by integrating endocrinologists/bone specialists into the multidisciplinary team which manages the patients. Antiresorptive agents such bisphosphonates and denosumab can increase BMD in PC patients.