<p><strong> </strong><strong>Clinicians should recommend preventive treatment for fractures and skeletal-related events, including supplemental calcium, vitamin D, smoking cessation, and weight-bearing exercise, to advanced prostate cancer patients on ADT. (<em>Clinical Principle</em>)</strong></p>
Discussion
Discussion
<p>For patients with advanced prostate cancer, there is insufficient evidence to inform the optimal strategies for the prevention of bone loss and frailty fractures. However, for most patients, it is reasonable to inform patients about the tenets of bone health based on bone physiology, expert opinion, and syntheses of available clinical evidence.<sup>155</sup></p>
<p>The U.S. National Osteoporosis Foundation provides easy to use recommendations for bone health maintenance (<a href="https://www.nof.org/preventing-fractures/prevention/" target="_blank" rel="noopener">https://www.nof.org/preventing-fractures/prevention/</a>). Recommendations include weight bearing exercises, muscle building exercises, balance exercises, smoking cessation, reduction of alcohol intake, and adequate intake of calcium and vitamin D.<sup>155</sup> The estimated daily calcium requirement is 1,000 to 1,200mg from food and supplements. The estimated daily vitamin D requirement is 1,000 IU from food, supplements, and sunlight.<sup> </sup><sup>155</sup></p>