Pathophysiology
Sex-steroid suppression → ↑ osteoclast activity → rapid bone loss (~3–5 %/year under ADT or AI).

Key numbers

  • DEXA T-score ≤ −2.0 = osteoporosis.

  • Vertebral fracture risk ↑ 2–3 × after 2 years continuous ADT.

Prophylaxis

Agent Dose Route / Interval Notes
Zoledronic acid (Zometa®) 4 mg IV q 6–12 mo Renal adjust; dental clearance first
Denosumab (Prolia®) 60 mg SC q 6 mo No renal adjust; risk hypocalcemia
Calcium + Vit D 1200 mg + 800–1000 IU daily Oral Mandatory with both

Exercise prescription

  • Weight-bearing + resistance ≥ 3 ×/week.

  • Fall-prevention: proprioception training + balance.

Dental rules

  • Baseline dental exam.

  • No implants or extractions during bisphosphonate/denosumab use; defer ≥ 3 mo pre/post-procedure.

  • Immediate referral if exposed bone or jaw pain → suspect osteonecrosis of the jaw (ONJ).

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