Exploring the effects of luteinizing hormone-releasing hormone agonist therapy on bone health: implications in the management of prostate cancer.

Osteoporosis is a complication that may be associated with long-term androgen deprivation therapy (ADT) in men with prostate cancer. Androgen deprivation increases bone resorption, thereby leading to a more rapid decrease of bone mineral density (BMD) at multiple skeletal sites as compared with age-matched healthy men. ADT has been associated with an increased risk of skeletal fracture in several retrospective analyses. The role of androgens in maintaining bone health appears to be mediated indirectly through their conversion to estrogens, although testosterone may be an important factor in bone formation. Physicians need to be aware of the potential for osteoporosis and should inform patients of appropriate lifestyle and diet modifications, such as calcium and vitamin D supplementation, and exercise at the initiation of ADT. Evaluating BMD may become the accepted norm. Several studies suggest that bisphosphonates may be beneficial in preventing and treating osteoporosis in patients with prostate cancer. The overall benefit of ADT in men with prostate cancer will continue to improve as potential side effects, such as osteoporosis, are recognized and addressed successfully.