Osteoporosis drugs counter deleterious effects of ADT on bone health
medwireNews: Among men receiving androgen deprivation therapy (ADT) for nonmetastatic prostate cancer, treatment with bisphosphonates and denosumab improves bone mineral density (BMD), shows a meta-analysis.
Denosumab is also associated with a reduced risk for radiographic vertebral fractures, but the finding is based on just one trial, the Canadian research team notes in the Annals of Internal Medicine.
The meta-analysis included two systematic reviews and 28 reports of 27 clinical trials evaluating the effects of a drug, supplement, or lifestyle intervention on bone health in men with nonmetastatic disease who were initiating or continuing ADT.
Pooling data from 20 studies comparing bisphosphonates with placebo or usual care showed a significant improvement with bisphosphonates with regard to changes from baseline to 12 months in BMD at the lumbar spine, femoral neck, and total hip, with average differences between the groups of 6.3%, 3.0%, and 2.7%, respectively.
In a subgroup analysis, intravenous, but not oral, bisphosphonates were significantly associated with improved BMD at the lumbar spine, but no such effect was observed for the femoral neck or total hip.
A single trial of the receptor activator of nuclear factor κ-B ligand (RANKL) inhibitor denosumab also showed improvements in BMD relative to placebo, as did a trial each of the selective estrogen receptor modulators toremifene and raloxifene. But three trials assessing exercise-based interventions did not find a significant difference between exercise and usual care in terms of change in BMD.
Shabbir Alibhai (McMaster University, Hamilton, Ontario) and study co-authors report that one high-quality trial of denosumab demonstrated a significant reduction in the incidence of radiographic vertebral fractures compared with placebo, at 12 (0.3 vs 1.9%), 24 (1.0 vs 3.3%), and 36 (1.5 vs 3.9%) months.
And in one placebo-controlled trial of moderate quality, treatment with toremifene was associated with a lower rate of all (6.3 vs 10.1%) and radiographic vertebrate fractures (2.5 vs 4.9%), but the agent is not licensed in the USA or Canada, say the researchers.
They conclude that this meta-analysis highlights “the need for additional trials in this population that are designed to detect reductions in fractures,” including large placebo-controlled or active comparator trials of bisphosphonate and of newer agents such as abaloparatide and romosozumab.
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