<p><strong> </strong><strong>Clinicians should discuss the risk of osteoporosis associated with ADT and should assess the risk of fragility fracture in patients with advanced prostate cancer. (<em>Clinical Principle</em>)</strong></p>
Discussion
Discussion
<p>Individuals with metastatic prostate cancer are at a high risk of bone complications due to age-related and treatment related loss in bone mineral density.<sup>145-147</sup><sup> </sup> The Fracture Risk Assessment Tool (<a href="https://www.sheffield.ac.uk/FRAX/">https://www.sheffield.ac.uk/FRAX/</a>) is a validated resource to help predict a patient’s ten-year probability of hip fracture and the ten-year probability of a major osteoporotic-related fracture (e.g., spine, forearm, hip or shoulder fracture). This tool can be used with or without measurement of bone mineral density.</p>
<p>Baseline bone mineral density measurement with dual x-ray absorptiometry (DXA) may be considered in men receiving androgen deprivation and other systemic treatments for prostate cancer.<sup>148, 149</sup><sup> </sup>Several observational studies have assessed changes in bone mineral density.<sup>150-154</sup><span> </span><sup> </sup>Many of these studies reveal that the largest decrease in bone mineral density occurs within the first year of therapy, although bone loss has been observed beyond one year of therapy. Based on these observational studies, it would be reasonable to re-assess osteoporotic-related risk (FRAX® and DXA) one-year after initiating systemic treatment, and at longer intervals thereafter.</p>