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.

ADT is the most common therapy used in men diagnosed with prostate cancer. But the therapy “is associated with many potential adverse effects, including significant bone loss and increased risk for low trauma or fragility fractures similar to that in persons with primary osteoporosis,” researchers wrote.

The new study by researchers at the University to Toronto found that non-metastatic prostate cancer patients starting or continuing ADT had significantly less BMD loss when they were given bisphosphonates (a class of medicines that slow down or prevent bone loss) and Prolia (the only FDA-approved therapy for cancer treatment-induced bone loss), compared with those receiving a placebo, normal care, or other active treatments.

“This is welcoming news as nearly half of all men with non-metastatic prostate cancer will receive ADT at some point,” David Samadi, MD, chairman of urology at New York’s Lenox Hill Hospital, said in a press release. “However, an unfortunate side effect of ADT is the potential for significant bone loss. This makes it imperative that a man would need to be aware of this as even a minor injury can make them susceptible to a fracture, similar to what you would see in someone with osteoporosis.”

The review set out to evaluate the effectiveness of drug, supplement, and lifestyle interventions currently employed as measures to prevent fractures, improve BMD, and delay osteoporosis in non-metastatic prostate cancer patients.

Bisphosphonates were found to increase BMD over a placebo, but had no effect at preventing fractures among patients with non-metastatic prostate cancer. Prolia, administered subcutaneously every six months in a 60 mg concentration, improved BMD and reduced the incidence of new vertebral fractures, according to the results of one clinical trial.

According to Samadi, “this study should remind all urologists of the gap in regards to bone health care for men with prostate cancer. More testing of bone mineral density both before and during ADT treatment is an important step in identifying those men who may be at risk.”

“One beginning step is to do a risk assessment tool evaluating men with prostate cancer receiving ADT and educating them on the adverse effects of ADT. We also need to be mindful of talking to our patients about their diet and lifestyle making sure they are getting adequate sources of calcium and exercising regularly,” Samadi said.

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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