Alendronate’s Effect on Bone Loss in Men Treated with Hormonal Therapy for Prostate Cancer

Summary and Comment |
April 2, 2007

Alendronate’s Effect on Bone Loss in Men Treated with Hormonal Therapy for Prostate Cancer

  1. Robert Dreicer, MD, MS, FACP

Compared with placebo, an oral bisphosphonate significantly improved BMD and lessened bone turnover in men who were receiving ADT.

  1. Robert Dreicer, MD, MS, FACP

Androgen-deprivation therapy (ADT) for patients with prostate cancer has risen dramatically during the past decade in the U.S., primarily because it is now used in patients with nonmetastatic disease (i.e., rising prostate-specific antigen [PSA]-only disease). Men with metastatic disease survived for about 2 to 4 years after diagnosis, and short-term therapy-related complications were minimal, giving ADT a good risk-benefit ratio. However, in men without overt metastatic disease, the typical natural history is substantially longer, and long-term exposure to ADT is common. Compelling evidence shows that men who receive ADT exhibit bone loss and increased fracture risk compared with men who do not receive ADT.

To investigate whether cotherapy with the bisphosphonate alendronate, which has proven ability to retard or reverse osteoporosis, would slow bone loss or improve bone mass, 112 men (age, ≤85) with nonmetastatic prostate cancer were enrolled in a randomized double-blind trial at a single center in Pennsylvania. At baseline, 39% of men had osteoporosis, and 52% had low bone mass. Median ADT duration was 14 months. Oral alendronate (70 mg once weekly) or placebo was administered for 1 year; all patients received vitamin D and calcium supplementation. Patients underwent assessment of bone-mineral density (BMD) of the spine and hip and of markers of bone resorption and formation at baseline and at 1 year.

In the alendronate group, BMD increased significantly from baseline, by 3.7% (P<0.001) in the spine and by 1.6% in the femoral neck (P=0.008). In the placebo group, losses of 1.4% and 0.7%, respectively, were recorded. Bone turnover significantly decreased from baseline in alendronate patients only. No between-group differences in adverse events were observed. The study was not powered to evaluate differences in fracture rates.

Comment

Evidence is accumulating to show that ADT exerts substantial adverse effects, including diminishing BMD, worsening obesity, and enhancing risk for diabetes and cardiovascular disease, in men who are being treated for prostate cancer. These researchers showed that once weekly alendronate can increase BMD and decrease bone turnover in such men, but the substantial increase in ADT courses that are administered for nonmetastatic prostate cancer remains largely unsupported by prospective evidence. Preventing bone loss in men who, in fact, might not need ADT in the first place remains an issue for consideration.

Citation(s):

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.