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Osteoporosis associated with androgen-deprivation therapy — MSRA MCQ

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ModerateProstate CancerOsteoporosis associated with androgen-deprivation therapyMSRA

A 73-year-old man with CPG4 localised prostate adenocarcinoma has received goserelin for 6 months alongside radical radiotherapy. The oncology plan is to continue androgen-deprivation therapy for a total of 3 years. Before treatment, he had a low-trauma distal radius fracture aged 69 years. A baseline DXA scan, arranged because of planned long-term androgen deprivation, shows a femoral-neck T-score of −2.7. His eGFR is 68 mL/min/1.73 m², adjusted calcium is normal, and he has no oesophageal disease or swallowing difficulty. Which is the most appropriate management of his bone health now?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Offer bisphosphonate treatment for confirmed osteoporosis

Explanation lettering: D = shown as A · A = shown as D

D is correct. He has established osteoporosis on DXA (T-score −2.7) and a previous fragility fracture, in the context of planned long-term androgen-deprivation therapy (ADT), which accelerates bone loss. NICE recommends offering bisphosphonates to people receiving ADT who have osteoporosis. His preserved renal function, normal calcium and absence of oesophageal contraindications provide no reason to bypass bisphosphonate therapy. A is insufficient because surveillance alone does not treat confirmed osteoporosis; repeat risk assessment or DXA may have a role later but should not replace treatment. B is plausible because denosumab is effective for osteoporosis in people receiving ADT, but NICE positions it for use when bisphosphonates are contraindicated or not tolerated. C addresses modifiable bone-health factors but is inadequate as sole management in established osteoporosis. E confuses osteoporosis management with prevention of skeletal morbidity from metastatic bone disease; bisphosphonates should not be prescribed simply to prevent bone metastases, and this man has no metastatic disease.

Reference: NICE NG131: Prostate cancer: diagnosis and management — Managing adverse effects of hormone therapy, osteoporosis (Last updated 15 December 2021) — https://www.nice.org.uk/guidance/ng131/chapter/Recommendations NICE CG146: Osteoporosis: assessing the risk of fragility fracture — Recommendations (2012) — https://www.nice.org.uk/guidance/cg146/chapter/Recommendations