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Definition |
Due to increased bone turnover and decreased BMD in a time-dependent manner, ADT use is linked to an increased risk of fracture (up to 45% relative risk with long-term ADT). Hip fractures in men are associated with a significant risk of death. A precise evaluation of BMD should be performed by dual emission X-ray absorptiometry (DEXA) before starting long-term ADT. An initial low BMD (T-score < -2.5 or < -1, with other risk factors) indicates a high risk of subsequent non-metastatic fracture. The WHO FRAX tool (http://www.shef.ac.uk/FRAX) should be used to evaluate individual risk. Obesity (increase in body fat mass by up to 10%) and sarcopenia (decrease in lean tissue mass by up to 3%) are common and occur during the first year of ADT. Both changes increase the fracture risk.
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