The administration of androgen deprivation therapy (ADT) is associated with significant bone mineral density loss. To counter this, a variety of options are available that can be administered to prevent or treat skeletal-related events.

A few approaches to promote bone health, that urologists often forget to recommend, include exercise and vitamins, suggests Stephen J. Freedland, MD. Exercise has been shown to preserve bone and bone density, specifically in men on ADT. Moreover, supplementation with calcium and 800 IU of vitamin D helps maintain bone health.

Supplementation and exercise remain important, even when utilizing more aggressive treatments, such as denosumab, notes David Albala, MD. In general, bone mineral loss begins the moment ADT is begun, making prophylactic measures more important. With the addition of novel therapies, it has become even more important to stress the importance of bone health to patients, believes Vahan Kassabian, MD.

Bone health remains an education hurdle that must be overcome for most urologists, believes moderator, Raoul S. Concepcion, MD. An optimal approach, in addition to supplements and exercise, is to begin treatment with denosumab at the same time as LHRH therapy.