Changes in bone health and skeletal-related events following implementation of a multidisciplinary consensus statement guiding surveillance and treatment of men undergoing androgen deprivation therapy for prostate cancer

Figures & data

Table I.  The impact of ADT on bone health.

Reference	No. of patients	Type of castration	BMD site (% decrease)
			Hip	Radius	Spine
Erikson et al. [7]	11	Surgical	−9.6	−4.5
Maillefert et al. [8]	12	Medical	−3.9		−4.6
Daniell et al. [9]	26	Surgical or medical ± antiandrogen	−2.4		−2.3
Berruti et al. [10]	35	Medical × 6 weeks	−0.6		−2.3
Higano et al. [11]	36	CAB	−2.7		−4.7
Higano et al. [12]	17	Intermittent CAB	−2.5		−4.5
Smith et al. [13]	22	CAB × 4 weeks	−1.8		−3.3
Smith et al. [14]	37	Medical ± antiandrogen	−2.8		−2.2
Mittan et al. [15]	28	Medical	−3.3	−5.3

The negative effect of ADT on bone mineral density has been well documented. Regardless of the type of castration, bone health is shown to decrease. Several methods of prevention have been studied to halt this bone loss.

Table II.  Baseline and periodic BMD study.

T-score <1SD below mean	T-score 1–3SD below mean	T-score > 3SD below mean
↓	↓	↓
• Lifestyle modifications*	• Lifestyle modifications*	• Lifestyle modifications*
• Vitamin D, Ca^2 supplementation^†	• Vitamin D, Ca^2 supplementation^†	• Vitamin D, Ca^2 supplementation^†
	• Oral Fosamax^‡	• IV Bisphosphonate^§

Table III.  Demographics and results of screening and treatment before and after implementation of the MCS.

	Pre	Post	p-value
Patients (no.)	96	45	–
Age (years)	78	80	0.187
Treatment length (months)	43	80	<0.0001
At least one BMD test (%)	38	89	<0.0001
Calcium/Vitamin D (%)	56	97	<0.0001
Bisphosphonates (%)	23	64	<0.0001
T-score (femur)	0.875	0.847	0.528
T-score standard deviation (femur)	−1.507	−1.678	0.609
Z-score	0.359	0.442	0.703
Total bone loss (no.)	29	25	0.742
Osteopenia, no. (%)	15 (52)	16 (63)	0.420
Osteoporosis, no. (%)	8 (28)	7 (29)	0.850
Severe osteoporosis, no. (%)	6 (20)	2 (8)	0.283
Skeletal-related events (no.)	23	13	0.145

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