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Dietary risk factors for bone loss among men undergoing androgen deprivation therapy for the treatment of prostate cancer Wiens, Kristin Patricia

Abstract

Androgen deprivation therapy (ADT) is the preferred mode of treatment for patients with recurrence of prostate cancer (PC) following definitive treatment and locally advanced disease. With more men commencing ADT earlier in the treatment trajectory and for longer duration, the side effects of ADT are becoming more prevalent and of greater concern to clinicians. ADT can have serious adverse effects on bone mineral density (BMD) and metabolism, leading to the development of osteopenia or osteoporosis. This study was a cross-sectional investigation of dietary risk factors for bone loss, particularly calcium and vitamin D intakes, among men undergoing ADT for the treatment of non-metastatic PC (n = 12), hormone-naïve men with PC (n = 21) and healthy controls (n = 20). Outcome measures were dietary intake of calcium and vitamin D assessed by diet history questionnaire, as well as vitamin D status as assessed by serum 25-hydroxyvitamin D and parathyroid hormone levels. There were no between-group differences in calcium or vitamin D intake from food, supplements or both. When compared with the current Adequate Intake and treatment-specific guidelines, the majority of men did not meet current recommendations. Adherence to current dietary guidelines for the prevention of osteoporosis among men undergoing ADT was poor, with 91.7% falling short of the recommended 1500 mg of calcium per day, and no men meeting the treatment-specific recommendation of 20 mcg of daily vitamin D. In addition to inadequate calcium and vitamin D intakes, several additional dietary risk factors present among study participants further increase risk of bone loss and osteoporosis in this group of men. Vitamin D status was also not different among groups; however, serum values quantitated by the assays were well outside expected values, and it was concluded that the assays were likely not valid. The results of this study demonstrate the need for provision of nutrition information to these men at time of therapy commencement and on an ongoing basis throughout treatment, as a means of preventing or reducing the negative effects of ADT on nutritional status and quality of life.

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