Understanding treatments for bone loss and bone metastases in patients with prostate cancer: a practical review and guide for the clinician

Prostate cancer patients frequently develop skeletal complications, including bone loss resulting from prolonged androgen deprivation therapy (ADT) in nonmetastatic and metastatic disease and bone metastases. Prevention and treatment of bone loss and bone metastases with bisphosphonates, potent bone-resorption inhibitors, are evolving. Only zoledronic acid has been shown to reduce and delay bone complications in patients with hormone-refractory disease; clinical trials are evaluating bisphosphonate treatment in hormone-naive patients with bone metastases and in preventing bone metastases in patients with high-risk disease. Prostate cancer patients beginning ADT should be assessed clinically and radiologically for pre-existing bone loss; encouraged to modify lifestyles that increase the risk for bone loss and fractures; participate in a customized resistance-exercise program; take supplemental calcium and vitamin D; and be assessed regularly for bone loss during ADT. Patients with osteoporosis should receive bisphosphonate therapy; some patients with osteopenia may also benefit from bisphosphonate therapy. Drugs targeting specific mediators of bone remodeling seem promising and are being evaluated in clinical trials.