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Therapy Insight: osteoporosis during hormone therapy for prostate cancer

Nature Clinical Practice Urology volume 2, pages 608–615 (2005)Cite this article

Abstract

The intended therapeutic effect of gonadotropin-releasing-hormone (GnRH) agonists is hypogonadism, which is a leading cause of osteoporosis in men. Observations are consistent with this effect: GnRH agonists decrease bone mineral density and increase fracture risk in men with prostate cancer. Estrogens play a central role in homeostasis of the normal male skeleton and evidence suggests that estrogen deficiency is primarily responsible for the adverse skeletal effects of GnRH agonists. The mechanism of treatment-related bone loss involves acceleration of physiologic bone turnover. In small, randomized, controlled trials, bisphosphonates (pamidronate, zoledronic acid) and selective estrogen-receptor modulators (raloxifene, toremifene) increased bone mineral density in GnRH-agonist-treated men. Two ongoing large, randomized, placebo-controlled studies will prospectively define fracture outcomes in men with prostate cancer and assess the efficacy of novel pharmacologic interventions (AMG 162, toremifene) in GnRH-agonist-treated men.

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Authors and Affiliations

  1. Assistant Professor of Medicine at Harvard Medical School and an Assistant Physician in the Hematology–Oncology Division at Massachusetts General Hospital, Boston, MA, USA

    Matthew R Smith

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  1. Matthew R Smith
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Correspondence to Matthew R Smith.

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Dr Matthew R Smith is a consultant for Amgen, GTx Inc., and Novartis Oncology.

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Smith, M. Therapy Insight: osteoporosis during hormone therapy for prostate cancer. Nat Rev Urol 2, 608–615 (2005). https://doi.org/10.1038/ncpuro0326

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