Keeping Bone Health Top of Mind in Androgen Deprivation Therapy

Daniel P. Petrylak, MD, of the Yale School of Medicine in New Haven, Connecticut, notes that bone health is a frequently underappreciated aspect of care for patients with prostate cancer. Because androgen deprivation therapy is known to cause rapid bone loss, he advocates for a proactive management strategy that begins at the onset of treatment. For patients with castration-sensitive disease, his diagnostic approach is dictated by the extent of the cancer.

Although he generally does not perform DEXA scans for patients with high-volume metastatic disease, he considers a baseline DEXA scan essential for patients with low-volume or nonmetastatic disease to screen for underlying conditions such as osteopenia or osteoporosis.

Once a patient's bone density status is established, Petrylak implements a comprehensive treatment plan to preserve skeletal integrity. He initiates calcium and vitamin D supplements for all patients immediately, as these are foundational for countering the bone-depleting effects of hormonal therapy. For those who show signs of significant thinning on their scans, he prescribes specific anti-resorptive agents to stabilize the bone.

Beyond pharmacological intervention, Petrylak emphasizes that lifestyle modifications are a vital, though often forgotten, component of maintenance. He consistently recommends a vigorous exercise program for his patients, provided they have no medical contraindications such as cardiovascular disease, to help naturally sustain bone density throughout their treatment journey.