Maureen E. O'rourke, RN, PhD

Osteoporosis, the most common late effect of cancer treatment in the US, occurs with greater frequency among cancer survivors than the general population. Survivors of breast cancer, prostate cancer, and childhood leukemia are at particularly high risk for changes in bone mineral density (BMD) / osteoporosis that can lead to fractures.[1] In breast and prostate cancer patients, bone effects are often the result of endocrine therapy–induced alterations in bone microarchitecture. They also can be caused by other types of cancer therapy, vitamin D deficiency, and other physiological changes that may or may not be related to cancer or its treatment. In childhood leukemia patients, bone effects can be caused by a variety of factors, including corticosteroid therapy, radiation therapy to the brain, and the disease itself.

The patient is a 74-year-old male in generally good health. He reported having several episodes of prostatitis over the past 5–10 years. His prostate-specific antigen (PSA) levels rose to 5 ng/mL from an initial value of 2.6 ng/mL. Biopsies at this time were positive for malignancy in both lobes, clinical stage T2. His Gleason score was 6, suggesting that he had a favorable prognosis with a low risk of recurrence.