From the meta-analysis by Lassemillante et al. 1 in this issue of the Journal, it is clear that there is a high prevalence of osteoporosis and low bone mass (osteopenia) by dual energy x-ray absorptiometry (DXA) in men treated with androgen deprivation therapy (ADT) for prostate cancer. While the prevalence of osteoporosis varied among the cited studies, there is no doubt that the impact of ADT on bone mineral density, and therefore, fracture risk is underappreciated by patients and medical professionals. ADT may include analogs of gonadotropin releasing hormone (GnRH), androgen receptor blockers, or a combination of the two. In the past and rarely today, orchiectomy has been used to lead to a hypogonadal state. It is important to note that the dramatic decrease of testosterone by GnRH analogs or orchiectomy also leads to very low levels of estradiol, which is of particular import for bone in older men 2. Prostate cancer patients treated with only androgen receptor blockade have less loss of bone than those treated with GnRH analogs or combined therapy 3.
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