It is well known that men who receive androgen deprivation therapy (ADT) after diagnosis of prostate cancer can experience significant bone loss as side effect of treatment. A new systematic review from the University of Toronto has found that bone mineral density (BMD) was effectively increased with bisphosphonates and denosumab in men with non-metastatic prostate cancer who received ADT.
“This is welcoming news as nearly half of all men with non-metastatic prostate cancer will receive ADT at some point,” said Dr. David Samadi. “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.”
Since bone loss and bone health is a concern in men with prostate cancer, the purpose of the study was to evaluate the effectiveness of drug, supplement, and lifestyle interventions aimed at preventing fractures, improving bone mineral density and either preventing or delaying osteoporosis in men with non-metastatic prostate cancer.
What the results of the study showed was that bisphosphonates were effective at increasing BMD, but no trial was sufficiently powered to detect reduction in fractures. Denosumab improved BMD and reduced the incidence of new radiographic vertebral fractures in 1 high-quality trial. None of the trials compared calcium or vitamin D versus placebo.
“The findings from the study showed that from baseline to 12 months later, there was a statistically significant difference that favored bisphosphonates over the placebo,” explained Dr. Samadi. “Biphosphonates are medications used to treat bone loss with the intent of reducing the risk of fractures. Bone is constantly undergoing a turnover process in which osteoblasts create bone and osteoclasts destroy it. Biphosphonates inhibit the actions of osteoclasts by promoting their apoptosis which, in turn, slows bone loss. The other medication studied in the review, Denosumab, is an injection, also used to treat osteoporosis to help prevent fractures.”
Dr. Samadi went on to add, “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.”
Patients newly diagnosed with prostate cancer can contact world renowned prostate cancer surgeon and urologic oncologist, Dr. David Samadi, for a free phone consultation and to learn more about prostate cancer risk, call 212-365-5000.Health articles