Practical guide to bone health in the spectrum of advanced prostate cancer.

INTRODUCTION In the advanced stage of prostate cancer, bone is consistently the first and, later on, the dominant extra-nodal metastatic site. Bone metastases account for most of prostate cancer's morbidity. MATERIALS AND METHODS We have performed a literature review using the MEDLINE database for publications on: 1) bone metastases (androgen deprivation therapy); 2) cancer treatment induce bone loss; 3) skeletal related events; 4) denosumab; 5) zoledronic acid. RESULTS Prostate cancer cells disrupt the normal bone remodeling process, invade the skeletal environment, and ultimately weaken the bone structure. This may result in skeletal complications, also known as skeletal related events (SREs), including pain, fractures, spinal cord compressions requiring surgery, radiotherapy or change in anti-cancer treatments. SREs negatively impact quality-of-life and survival and represent a major cost for the healthcare system. The bone metastases conundrum is further aggravated by the fact that androgen deprivation therapy (ADT), the reference systemic treatment of advanced prostate cancer, profoundly affects the skeletal integrity as well. ADT accelerates the physiological bone resorption, leading to osteoporosis and fragility fractures. CONCLUSION The concept of "bone health" or "skeletal heath" refers to the diagnostic, prevention, and treatment of cancer treatment induced bone loss (CTIBL) and metastasis, and their respective complications, osteoporotic fractures and SREs.