Bone Health in Prostate Cancer Survivors: Recent Lessons and Opportunities for Improvement

Prostate cancer survivors face an elevated lifetime risk of fracture due to factors that include older age, bony metastases, and use of androgen deprivation therapy in the curative setting, which increases the risk of osteoporosis and fracture. Management of bone health is critical to prevent fracture and other bone-related complications; however, routine bone health screening is seldom performed and is inadequate. In this mini-review, we discuss optimal bone health management for prostate cancer survivors who have received curative-intent therapy. We also discuss areas for future improvement. PATIENT SUMMARY: This mini-review discusses the importance of bone health for prostate cancer survivors who had nonmetastatic disease, steps to improve bone health, and areas for improvement.

Korean Guideline for the Prevention and Treatment of Glucocorticoid-induced Osteoporosis

Background

To develop guidelines and recommendations to prevent and treat glucocorticoid (GC)-induced osteoporosis (GIOP) in Korea.

Methods

The Korean Society for Bone and Mineral Research and the Korean College of Rheumatology have developed this guideline based on Guidance for the Development of Clinical Practice Guidelines ver. 1.0 established by the National Evidence-Based Healthcare Collaborating Agency. This guideline was developed by adapting previously published guidelines, and a systematic review and quality assessment were performed.

Results

This guideline applies to adults aged ≥19 years who are using or plan to use GCs. It does not include children and adolescents. An initial assessment of fracture risk should be performed within 6 months of initial GC use. Fracture risk should be estimated using the fracture-risk assessment tool (FRAX) after adjustments for GC dose, history of osteoporotic fractures, and bone mineral density (BMD) results. All patients administered with prednisolone or an equivalent medication at a dose ≥2.5 mg/day for ≥3 months are recommended to use adequate calcium and vitamin D during treatment. Patients showing a moderate-to-high fracture risk should be treated with additional medication for osteoporosis. All patients continuing GC therapy should undergo annual BMD testing, vertebral X-ray, and fracture risk assessment using FRAX. When treatment failure is suspected, switching to another drug should be considered.

Conclusions

This guideline is intended to guide clinicians in the prevention and treatment of GIOP.

Delayed diagnosis of an unsuspected pelvic fracture in a patient with tetraplegia

STUDY DESIGN

Case report.

CONTEXT

In patients with a complete spinal cord injury (SCI) above T6 level, autonomic dysreflexia (AD) can be the only alerting sign of complications below the level of injury. A case report is presented of a patient with tetraplegia who progressively developed an AD syndrome after falling from a wheelchair. Initially, he was treated for symptomatic urinary tract infection and only later an unstable pelvic fracture was detected.

FINDINGS

A patient with chronic tetraplegia fell from his wheelchair while intoxicated. After the fall, he showed no signs of injury. Two days later, AD symptoms appeared while lying on his side or sitting. He presented to his community-based physician and received antibiotics for concomitant urinary tract infection. Because of persisting complaints, the patient was referred to the Spinal Cord Unit. Once the history of falling from the wheelchair was made known, symptoms of AD were suggestive of an internal injury. Radiography showed pelvic fracture and conservative treatment was administered. The fractures healed in 3 months, the therapeutic bed rest regimen was relaxed without trigerring AD symptoms.

CONCLUSION

AD symptoms can suggest complications below the SCI level. Awareness and recognition of these symptoms are of utmost importance. However, etiology may be misleading. The role of a community-based general physician is to recognize the right moment when the need of a specialized assessment in a Spinal Cord Unit arises. In addition, patients should also be well informed about the most common possible complications from specialized SCI centers.