Bone Health in Patients With Prostate Cancer Treated With Androgen Deprivation Therapy: Risk Assessment and Practical Recommendations

Androgen deprivation therapy (ADT) represents a cornerstone in the treatment of prostate cancer (PC); however, its use is associated with an accelerated deterioration of bone health as a consequence of treatment-induced hypogonadism. Patients receiving ADT experience a rapid loss of bone mineral density (BMD), especially during the first year of therapy, leading to a clinically significant increase in the risk of osteoporosis and fragility fractures. These bone complications are associated with a significant negative impact on quality of life, morbidity and mortality, and healthcare costs. This article aims to provide a critical and practical review of pathophysiology, risk factors, assessment methods, and strategies for the prevention and treatment of ADT-induced bone loss in patients with prostate cancer. Current recommendations from major clinical guidelines are analyzed, highlighting the importance of systematic bone risk assessment using bone densitometry and risk stratification tools like Fracture Risk Assessment Tool (FRAX®). Evidence-based interventions are also reviewed, ranging from lifestyle modifications and calcium and vitamin D supplementation to the use of antiresorptive therapies in selected patients, to provide a comprehensive and clinically applicable approach for daily practice.