Increasingly, we are using androgen deprivation therapy (ADT) either alone or in combination with radiation therapy for the treatment of localized, high-risk, or the biochemical relapse of prostate cancer (recurrent pc).
Many studies have clearly demonstrated that bone mineral density (BMD) loss is rapid, especially during the first year of ADT. As much as 4.6% of total hip, femoral neck, and lumbar spine BMD loss has been reported in pc patients without bone metastases.
In prospective studies, concurrent administration of bisphosphonates causes a significant increase in the BMD. Retrospective studies of patients who receive ADT but did not also receive bisphosphonate therapy demonstrated a 21-37% increase in their fracture risk.
With this level of potential bone loss and the significant increased fracture risk we experience when on ADT, we need to insist on aggressive bone density monitoring and therapy when required.
Future studies need to address the long-term impact of antiresorptive therapy (bisphosphonates etc.) on fracture rates and the impact of the therapy on the quality of life issues need to be done.
My insurance carrier, Oxford, will only cover one bone density scan each year. The potential risks require a more liberal policy from Oxford and the other insurance carriers.
Joel T Nwak MA, MSW
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