Prostate cancer: bisphosphonates, denosumab prevent bone loss from ADT

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  • Bisphosphonates increased bone mineral density (BMD) in men with nonmetastatic prostate cancer who received androgen deprivation therapy (ADT).
  • Denosumab increased BMD and also reduced risk for fracture in these men.

Why this matters

  • ADT is associated with risk for reduction in bone density and increased fracture.
  • This systematic review of drugs, supplements, and lifestyle interventions by the Genitourinary Cancer Disease Site Group of the Cancer Care Ontario (CCO) will help physicians effectively manage patients at risk.

Key results

  • At 12 mo, bisphosphonates vs placebo increased BMD at the lumbar spine (mean difference [MD], 6.3%; P<.001), femoral neck (MD, 3.0%; P<.001), and total hip (MD, 2.7%; P< .001).
  • Denosumab vs placebo reduced new radiographic vertebral fractures at 12 mo (relative risk [RR], 0.15; P=.004), 24 mo (RR, 0.31; P=.004), and 36 mo (RR, 0.38; P=.006).
  • Raloxifene, toremifene, and denosumab showed statistical improvement in BMD.
  • No significant improvement in BMD was seen with exercise interventions.

 Study design

  • 2 systematic reviews and 27 eligible randomized controlled trials till January 2017 were evaluated.
  • Funding: Cancer Care Ontario.


  • Studies on bisphosphonates were underpowered to detect effects on fracture.