Cancer Treatment-Induced Bone Loss (CTIBL) in Prostate Cancer: Pathophysiology, Preclinical Findings, and Treatment with Zoledronic Acid

Purpose Gonadotropin-releasing hormone (GnRH) agonists decrease bone mineral density (BMD) and increase fracture risk in men with prostate cancer. Annual zoledronic acid increases BMD in postmenopausal women, but its efficacy in hypogonadal men is not known. Patients and Methods In a 12-month study, 40 men with nonmetastatic prostate cancer who were receiving a GnRH agonist and had T scores more than −2.5 were randomly assigned to zoledronic acid (4 mg intravenously on day 1 only) or placebo. BMD of the posteroanterior lumbar spine and proximal femur were measured by dual-energy x-ray absorptiometry. Results Mean (± SE) BMD of the posteroanterior lumbar spine decreased by 3.1% ± 1.0% in men assigned to placebo and increased by 4.0% ± 1.0% in men assigned to zoledronic acid (P < .001). BMD of the total hip decreased by 1.9% ± 0.7% in men assigned to placebo and increased by 0.7% ± 0.5% in men assigned to zoledronic acid (P = .004). Similar between-group differences were observed for the femoral neck and trochanter. Serum N-telopeptide, a marker of osteoclast activity, decreased significantly after zoledronic acid treatment. Conclusion In men receiving a GnRH agonist, a single treatment with zoledronic acid significantly increased BMD and durably suppressed serum N-telopeptide levels for 12 months. Annual zoledronic acid may be a convenient and effective strategy to prevent bone loss in hypogonadal men.

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Zoledronic acid (ZA) effectively inhibits cancer treatment-induced bone loss (CTIBL) in postmenopausal women (PMW) with early breast cancer (BCa) receiving adjuvant letrozole (Let): 12 mos BMD results of the Z-FAST trial

Journal of Clinical Oncology ◽

10.1200/jco.2005.23.16_suppl.533 ◽

2005 ◽

Vol 23 (16_suppl) ◽

pp. 533-533 ◽

Cited By ~ 22

Author(s):

A. Brufsky ◽

W. G. Harker ◽

J. T. Beck ◽

R. Carroll ◽

E. Tan-Chiu ◽

...

Keyword(s):

Breast Cancer ◽

Zoledronic Acid ◽

Bone Loss ◽

Cancer Treatment ◽

Postmenopausal Women ◽

Early Breast Cancer

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Pharmacotherapy Options in Cancer Treatment-induced Bone Loss: Focus on Bisphosphonates

Clinical Medicine Therapeutics ◽

10.4137/cmt.s2064 ◽

2009 ◽

Vol 1 ◽

pp. CMT.S2064

Author(s):

Kouta Ito

Keyword(s):

Breast Cancer ◽

Prostate Cancer ◽

Bone Loss ◽

Cancer Survivors ◽

Cancer Treatment ◽

Small Sample ◽

Ablation Therapy ◽

Prostate Cancer Survivors ◽

Hormone Ablation ◽

Hormone Ablation Therapy

Bone loss and its associated risk of fracture is a serious long-term health issue for breast cancer and prostate cancer survivors. Hormone ablation therapy, in particular aromatase inhibitors (AIs) for breast cancer and androgen deprivation therapy (ADT) for prostate cancer, causes marked reduction in circulating estrogen or testosterone levels, resulting in increased bone resorption, decreased bone mineral density (BMD), and an increased risk of fragility fracture. In several clinical trials with small sample sizes and short follow-up periods, oral and intravenous bisphosphonates have been shown to improve BMD, but not actual fracture rates, in cancer patients on hormone ablation therapy. A number of professional organizations and expert panels recommend the use of bisphosphonates for selected patients at risk. Although bisphosphonates are generally well tolerated, physicians should be aware of safety concerns, including the risk of osteonecrosis of the jaw. With the growing number of older breast and prostate cancer survivors, additional research is needed to characterize patients who would benefit from pharmacotherapy and optimize strategies to prevent cancer treatment-induced bone loss.

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