Fig. 3. Algorithm for assessment of bone health in prostate cancer patients receiving ADT. Note regarding patients with mCRPC: Around 80% mCRPC patients develop bone metastases. In patients with bone metastases from CRPC at high risk for clinically significant SREs, ESMO guidelines recommend denosumab or zoledronate at doses higher than those required for protection against CTIBL alone. However, where mCRPC patients do not already receive bone protection for prevention of metastatic morbidity, in view of emerging data referred to in Section 3, it is strongly recommended that all such patients should be considered for bone protection to prevent osteoporotic fragility fractures.