Long recognized as a significant health issue for post-menopausal women, Osteoporosis also poses a significant risk to men on a Hormone Blockade (ADT). Osteoporosis, the loss of bone density, poses an immediate and direct risk of fractures to men on ADT!
A decline in the serum testosterone in men on ADT correlates with a decline in bone health. Several prospective trials have demonstrated that bone mineral density (BMD) is significantly decreased in men on ADT compared to men in a control group (Diamond TH, Higano CS, Smith MR etal., “Osteoporosis in Men with Prostate Carcinoma Receiving Androgen-Deprivation Therapy for Prostate cancer” Cancer (2004); pp892-899). A recent study from the Surveillance, Epidemiology, and End Result (SEER) and Medicare databases confirmed this conclusion.
Men on ADT need to take some general precautionary actions. A regular regime of weight bearing exercises, smoking cessation, avoidance of caffeine and alcohol excess will slow down, but not halt bone density loss.
Bisphosphonates have emerged as a significant agent in the fight to maintain bone health in men with prostate cancer and bone metastasis. Bisphosphonates clearly delay skeletal progression (Saad MR, Gleason DM, Murray R et al., “A Randomized, Placebo Controlled Trial of Zoledronic Acid in Patients with Metastic Prostate Carcinoma”, J Natl Cancer Inst., (2002) pp 1458-1468).
Anti resorptive agents (Zoledronic Acid) have been demonstrated to actually reverse BMD decline (Smith MR, Eastham J, Gleason DM et al., “Randomized Controlled Trial of Zoledronic Acid to Prevent Bone Loss in Men Receiving Androgen Deprivation Therapy for Non-Metastatic Prostate Cancer, J Urol (2003); 169(6): pp 2008-2012).
In addition to the measures already described you should talk with your doctor about adding vitamin D supplementation and having a Bone Mineral Density evaluation to establish your BMD baseline. Then, each year or so you should consider another BMD evaluation to check for Osteoporosis.
Once Osteoporosis or fractures develope you should consider starting a regime of bisphosphonates. Don’t forget weight bearing exercise will help to slow down BMD decline and will also provide you with additional health benefits.
Joel T Nowak MA, MSW