Men with nonmetastatic prostate cancer receiving androgen deprivation therapy (ADT) may see improvements in bone mineral density (BMD) and reduced risk of fractures if treated with bisphosphonates or denosumab, according to a study published in the Annals of Internal Medicine.

ADT is a frequently utilized therapy in the treatment of prostate cancer, but leads to significant BMD loss and greater risk of fractures. In this meta-analysis, researchers investigated the potential benefit of administering bisphosphonates or denosumab to prevent or delay osteoporosis in men.

Study authors pooled data from 2 systematic reviews and 27 randomized clinical trials that evaluated bone-targeting therapies in men with nonmetastatic prostate cancer receiving ADT, and assessed the incidence of fractures and BMD.

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The selected studies analyzed the incidence of fractures, comparing bisphosphonates and denosumab with placebo. Overall, no significant reduction in risk of fractures was seen with bisphosphonates vs placebo. Only patients taking denosumab had a lower risk of fracture.

Although a significant increase in BMD occurred in the bisphosphonate and denosumab groups, no evidence was found that supported an associated reduction in fracture risk among men with nonmetastatic prostate cancer.

The authors conclude “further trials powered to detect reduction in clinical fractures are needed.”


1. Alibhai S, Zukotynski K, Walker-Dilks C, et al. Bone health and bone-targeted therapies for nonmetastatic prostate cancer [published online August 8, 2017]. Ann Intern Med. doi: 10.7326/M16-2577