The prevention of fragility fractures in patients with non-metastatic prostate cancer: a position statement by the international osteoporosis foundation
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Luisella Cianferotti1, Francesco Bertoldo2, Marco Carini3, John A. Kanis4, Alberto Lapini3, Nicola Longo5, Giuseppe Martorana6, Vincenzo Mirone5, Jean-Yves Reginster7, Rene Rizzoli8 and Maria Luisa Brandi1
1Department of Surgery and Translational Medicine, University of Florence, University Hospital of Florence, Florence, Italy
2Department of Medicine, University of Verona, Verona, Italy
3Department of Urology, University of Florence, University Hospital of Florence, Largo Brambilla Florence, Italy
4Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, United Kingdom
5Department of Urology, University of Naples Federico II, Naples, Italy
6Department of Urology, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
7Department of Public Health, Epidemiology and Health Economics, University of Liege, CHU Sart-Tilman, Liege, Belgium
8Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
Maria Luisa Brandi, email: firstname.lastname@example.org
Keywords: osteoporosis, androgen deprivation therapy, ADT, FRAX, zoledronic acid
Received: April 27, 2016 Accepted: April 20, 2017 Published: May 18, 2017
Androgen deprivation therapy is commonly employed for the treatment of non-metastatic prostate cancer as primary or adjuvant treatment. The skeleton is greatly compromised in men with prostate cancer during androgen deprivation therapy because of the lack of androgens and estrogens, which are trophic factors for bone. Men receiving androgen deprivation therapy sustain variable degrees of bone loss with an increased risk of fragility fractures. Several bone antiresorptive agents have been tested in randomized controlled trials in these patients. Oral bisphosphonates, such as alendronate and risedronate, and intravenous bisphosphonates, such as pamidronate and zoledronic acid, have been shown to increase bone density and decrease the risk of fractures in men receiving androgen deprivation therapy. Denosumab, a fully monoclonal antibody that inhibits osteoclastic-mediated bone resorption, is also effective in increasing bone mineral density and reducing fracture rates in these patients. The assessment of fracture risk, T-score and/or the evaluation of prevalent fragility fractures are mandatory for the selection of patients who will benefit from antiresorptive therapy. In the future, new agents modulating bone turnover and skeletal muscle metabolism will be available for testing in these subjects.
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