Prolia, Osteoporosis Therapies Improve Bone Health in Prostate Cancer Patients, Review Suggests

Prolia, Osteoporosis Therapies Improve Bone Health in Prostate Cancer Patients, Review Suggests
A review of clinical trial results revealed that patients with non-metastatic prostate cancer receiving androgen deprivation therapy (ADT) can benefit from osteoporosis therapies, known as bisphosphonates, and from Prolia (denosumab), which significantly increase bone mineral density (BMD). The review, “Bone Health and Bone-Targeted Therapies for Nonmetastatic Prostate Cancer,” was published in the journal Annals of Internal Medicine.

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One comment

  1. Stephen B. Strum, MD, FACP says:

    Please see my comment published on the Annals of Internal Medicine website. Just about every review article on bone health in men receiving androgen deprivation therapy (ADT) neglects to discuss key issues relating to 1) initial assessment of bone status & 2) ongoing evaluation re adequacy of bone integrity treatments. Examples of the above 2 points follow.

    Baseline evaluation of bone mineral density (BMD) & bone resorption markers (BRMs) are rarely done or done correctly. DXA is NOT the gold standard in the evaluation of BMD in middle aged to older individuals, independent of sex or diagnoses. As we age we also have associated problems of degenerative joint disease, osteoarthritis, and vascular calcifications. These all confound BMD when using DXA (unless “lateral” DXA is obtained & that’s rare). Quantitative computerized tomography (QCT) from a dedicated study or extrapolated from CT abdomen or pelvis or even PET/CT is far more accurate. Following patients over years with DXA will yield false positive information since age-related confounding issues will increase BMD findings not related to actual improvement in bone density.

    Rarely do I see bone resorption markers (BRMs) assessed at baseline or during anti-resorptive therapies such as bisphosphonates or RANK ligand inhibitor (RANKLi) use (e.g., Xgeva, Prolia). In medicine there is a Goldilocks Principle (GLP) that simply relates “not to hot, not to cold, but just right”. Giving Xgeva, for example, monthly may be overdosing the patient if the BRMs show optimal results either at baseline or after starting the anti-resorptive agent. The most helpful labs that I have found for this assessment are DpD (deoxypyridinoline) on urine and CTx (C-terminal telopeptides of collagen I) on serum.
    More info at Annals webpage.

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