Table 3. Clinical assessment and management guidelines for ADT-associated cardiometabolic and skeletal adverse effects.

Cardiometabolic health

Metabolic risk assessment prior to ADT commencement: body mass index, waist circumference, blood pressure, fasting blood glucose, oral glucose tolerance test (if fasting glucose between 5.5 and 6.9 mmol l−1) and fasting lipid profile.

Six-monthly to yearly metabolic assessment during the first 24 months of ADT.

Lifestyle intervention and/or dietician to prevent weight gain and worsening of insulin resistance.

Smoking cessation.

Blood pressure <130/80 mm Hg.

Lipid targets according to NCEP ATP III treatment guidelines.

In men with diabetes, intensification of management as necessary to main HbA1c target.

Skeletal health

At commencement of ADT: assessment for history of minimal trauma fractures and risk factors for osteoporosis, aBMD measurement by DXA and, in men with osteopenia, postero-anterior as well as lateral thoracolumbar spine X-rays.

Yearly aBMD measurement during the first 24 months of ADT.

Advice regarding regular physical exercise, smoking cessation and alcohol consumption of ⩽2 standard drinks per day at each visit.

Total daily calcium intake of 1200–1500 mg through diet, supplements, or both, unless there is a history of renal calculi.

Vitamin D supplementation as necessary to achieve a target serum 25-hydroxyvitamin D level ⩾75 nmol l−1.

Commencement of treatment with a bisphosphonate in men with a minimal trauma fracture, an aBMD T-score of ⩽−2.5, or if 10-year absolute risk of a major osteoporotic fracture is >20%.

Abbreviations: aBMD, areal bone mineral density; ADT, androgen deprivation therapy; DXA, dual-energy X-ray absorptiometry; HbA1c, glycated haemoglobin; NCEP ATP III, National Cholesterol Education Program Adult Treatment Panel III.

Adapted from Cheung et al.⁶⁴ on behalf of the Endocrine Society of Australia, the Australian and New Zealand Bone and Mineral Society and the Urological Society of Australia and New Zealand.