Denosumab, bisphosphonates improve BMD in men with prostate cancer
Both denosumab and bisphosphonates enhance bone mineral density (BMD) in men with nonmetastatic prostate cancer who are receiving androgen deprivation therapy (ADT), according to a systematic review and meta-analysis. In addition, denosumab lowers the risk for radiographic vertebral fractures.
Researchers searched Medline (1946 to 19 January 2017), Embase (1980 to 18 January 2017) and the Cochrane Database of Systematic Reviews (19 January 2017) for randomized trials and systematic reviews of trials that were published in English; involved men with nonmetastatic prostate cancer; and compared bone-targeted therapies with placebo, usual care or other active treatments.
In total, there were two systematic reviews and 28 reports of 27 trials that met the inclusion criteria. All trials centred on men with nonmetastatic prostate cancer who were initiating or continuing ADT.
Although no trial was adequately powered to detect reduction in fractures, bisphosphonates were effective in improving BMD. Denosumab increased BMD and reduced the incidence of new radiographic vertebral fractures in one high-quality trial.
There were no trials comparing calcium or vitamin D vs placebo. In three intervention trials, there was no statistically significant difference seen in change in BMD between exercise and usual care.
These findings should be considered in light of several limitations. First, most trials were of moderate quality. Second, only two randomized controlled trials were designed to assess fracture outcomes. Finally, there was no study that examined the potential harms of treatments.
Thus, “more trials studying fracture outcomes are needed in this population,” according to researchers, adding that bone health is a significant concern in men with prostate cancer.