Effects of Androgen Deprivation Therapy on Peripheral Bone Health

Androgen Deprivation Therapy (ADT) in prostate cancer is associated with bone loss and increased fracture risk. Previous studies on the effects of ADT on bone have focused on areal bone mineral density (aBMD) from dual-energy X-ray absorptiometry (DXA) at the central skeleton. In contrast, the effects on peripheral aBMD, bone microarchitecture, and bone strength remain less well understood.

This two-year observational study aimed to investigate the changes in aBMD and volumetric BMD, bone area, microarchitecture, and strength following ADT initiation in men with PCa. A total of 115 men were included, of whom 43 were treated with zoledronic acid (ZOL+) from ADT initiation, and the other 72 were not (ZOL −), according to national guidelines.

Measurements were performed using DXA and high-resolution peripheral quantitative CT (HR-pQCT) at ADT initiation (T0) and after 24 months (T2). The results showed a significant decrease in aBMD at all measurement locations in the ZOL− group between T0 and T2. In contrast, the ZOL+ group exhibited no significant changes in aBMD or volumetric BMD at these sites.

The HR-pQCT measurements revealed significant changes in bone area, microarchitecture, and strength in the ZOL− group between T0 and T2, while the ZOL+ group showed no significant changes. These findings suggest that the absence of zoledronic acid may be associated with adverse effects on peripheral bone health in men with PCa.

It is essential to note that this study had a limited sample size and a short follow-up period, which may limit the generalizability of the results. Furthermore, the study did not investigate the mechanisms underlying the observed effects of zoledronic acid on peripheral bone health.

In the context of ADT in PCa, these findings highlight the need for further research on the effects of zoledronic acid on peripheral bone health and the development of strategies to mitigate these adverse effects.