Early onset Osteoporosis and ADT

[Aardvark4]

Hi all, not surte if this has been posted previously

The gold standard for measuring BMD is Dual-energy X-ray absorptiometry (DEXA).61 However, in patients treated with ADT the risk of fracture is often independent of DEXA values and it is frequently misclassified when based only on DEXA measurement.62 This occurs because ADT determines not only a reduction in BMD (generally slow and reversible) but also a qualitative damage to the trabecular microstructure (often rapid and not reversible).62,63 In fact, the high bone turnover induced by ADT determines a thinning and then the perforation of bone trabeculae which increases the risk of skeletal fractures which, however, can not be measured by DEXA.63 In fact, in the study by Greenspan et al many of the patients with PC undergoing ADT who experienced a vertebral fracture had fewer trabecular plaques and a higher erosion index than men without fracture despite having a normal BMD value on DEXA.62

In patients with PC treated with ADT, fractures typically occur during the first year and this observation reinforces the fact that skeletal fragility is prominently dependent on rapid microarchitectural damage of the bone trabeculae rather than on the low bone mass.63 To improve fracture risk assessment, the World Health Organization has computed a FRAX algorithm that accounts for demographic risk factors, alcohol/tobacco/glucocorticoid use and other relevant past personal or familial history.63 The FRAX tool calculates the probability of risk for bone fracture for the next 10 years.63 However, this tool does not include ADT treatment among the risk factors for developing skeletal fractures, therefore the FRAX score may also underestimate the risk in patients with PC treated with ADT.63 According to the ESMO guidelines, the management of bone health in patients treated with ADT is based on the criteria of Coleman et al.64 All patients starting ADT should be recommended and adequate calcium intake (1200 mg daily total from diet and supplements) and vitamin D supplementation (800–2000 IU daily). Additionally, patients should be encouraged to make lifestyle changes such as trying to quit smoking, reducing alcohol consumption and increasing physical activity. In patients who have a T score 65; T score 6 months) the use of bone-protecting agents (BPA) should be considered.64 In patients who do not meet these criteria, the risk of fractures should be monitored by repeating a DEXA every 1–2 years.64 Since Coleman’s criteria are mainly based on the BMD value and considering that, as previously mentioned, BMD does not exactly reflect the fracture risk, the exclusive use of these criteria to establish the use of BPA can lead to under-treatment in patients with PC treated with ADT. Therefore, BPA should probably be used as primary prevention in all patients who initiate ADT regardless of Coleman’s criteria.65 BPA should be started as soon as possible in patients undergoing ADT considering that most fractures occur within one year of starting ADT. Finally, BPA should be performed for the entire duration of the ADT as the risk of fracture has been shown to increase with increasing duration of ADT. A new DEXA should be performed at the end of ADT to evaluate whether to continue treatment with BPA.

Since we do not always have treatments available to improve the adverse events induced by hormonal therapies, the most studied therapeutic strategy is represented by the use of intermittent hormonal therapy. Several studies have demonstrated that intermittent ADT is associated with a reduced rate of side-effects and better quality of life than continuous ADT.70,87,93,104 However none of the trials that addressed intermittent versus continuous ADT in mHSPC patients showed a survival benefit but there was a constant trend towards improved OS with continuous ADT although most of these studies were non-inferiority trials.70,87,93,104 On the other hand, there is no evidence on intermittent hormonal therapy in patients with mHSPC treated with ADT + ARPI since all the trials that evaluated this combination did not provide for the use of intermittent therapy. It is possible that selected patients with mHSPC (eg patients with low disease burden who reach undetectable PSA values within a few months after starting hormonal therapy) may benefit from intermittent therapy in terms of reduction of side effects and improvement of quality of life without compromising the efficacy of the therapy. Therefore, future studies evaluating a de-intensification of treatments in patients with mHSPC are needed.

[petabyte]

This is the link?

pmc.ncbi.nlm.nih.gov/articl...

[Aardvark4 in reply to petabyte]

yes, that's the review the abstract is taken from, thanks.

[vintage42]

"… BPA should probably be used as primary prevention in all patients who initiate ADT… BPA should be started as soon as possible in patients undergoing ADT considering that most fractures occur within one year of starting ADT. Finally, BPA should be performed for the entire duration of the ADT as the risk of fracture has been shown to increase with increasing duration of ADT. A new DEXA should be performed at the end of ADT to evaluate whether to continue treatment with BPA."

That was the important part for me. I started ADT a year ago and a DEXA scan said my bones were good. The urologist recommended Prolia but I declined it because of its side effects, the hope that I could prevent bone loss by supplements and exercise, and the belief that I could check the bones with another scan after a year.

A year has passed during which I did almost daily weight exercises for an hour. I had no falls so no fractures. I find that I must wait another year for a DEXA scan. And I changed from a urologist to a medical oncologist who insisted that I start Prolia.

So I am starting Prolia after year of ADT. I hope that I did not postpone the Prolia too long, and that the results of the DEXA scan next year will show the bones are OK.

[Jewelrylady in reply to vintage42]

My husband gets Prolia every 6 months. and has not had any side effects from it. He’s had 4 shots so far. When we read the possible side effects I was totally freaked out. I spoke with a friend who is a doctor and she was getting Prolia and also had no side effects. Everyone is different, but I hope you will do well on it.

[maley2711 in reply to Jewelrylady]

Do you recall the reason(s) that Prolia injections and NOT Fosamax/Alendronate pills were advised? Proven superior efficacy, less likely serious side effects, or both of those....or some other reason?

[Jewelrylady in reply to maley2711]

Sorry, neither of us remember doctor recommending something else.

[j-o-h-n]

At first I thought BMD meant Bowel Movement Daily so I finally looked it up and it means Bone Mineral Density. Geez those DAAAPITA.

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Aardvark, Wikipedia

en.wikipedia.org › wiki › Aardvark

aardvark from en.wikipedia.org

Aardvarks are medium-sized, burrowing, nocturnal mammals native to Africa. Aardvarks are the only living species of the family Orycteropodidae and the order ...‎Aardvark (disambiguation) · ‎The Ant and the Aardvark · ‎Orycteropodidae · ‎Cerebusdae · ‎Cerebus

In my humble and ignorant opinion I think they should have been named Oddvarks.

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Good Luck, Good Health and Good Humor.

j-o-h-n