Such changes have implications in terms of reducing the age at which the individual falls below the functional capacity threshold, requiring a shift away from independent living and a reduced quality of life. Moreover, the increase in fat mass during ADT can lead to increased levels of total cholesterol and triglycerides19, 23 and consequently the possible development of cardiovascular complications.24Full figure and legend (15K)Bone mass and skeletal fracture Apart from a decline in muscle mass and strength, ADT treated men suffer a reduction in bone mass, and consequently bone strength, that contributes to an increased incidence of fracture and associated disability.25, 26 The ADT related bone losses are significant and exceed those of women experiencing early menopause.27 Recently, Greenspan et al.20 indicated that men with prostate cancer initiating ADT have a 5 to 10 fold loss of bone mineral density (g/cm2) compared to healthy controls or men with prostate cancer not on ADT. Importantly, following ADT, there is a significant dose relation between fracture risk and the number of LHRHa doses administrated.25 The reduced structural bone strength is compounded by the reduction in muscle strength and power, which has been related to increased falls incidence28 resulting in two separate side effects of ADT combining to greatly increase fractures due to falls.Insulin resistance and lipoprotein profile Recently, Basaria et al.29 suggested that men with prostate cancer undergoing long term ADT can develop insulin resistance and hyperglycemia and these metabolic alterations are independent of age and body mass index.
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