Effects of once-yearly zoledronic acid on bone density and incident vertebral fractures in nonmetastatic castration-sensitive prostate cancer patients with osteoporosis

Daisuke Watanabe,Ken Watanabe,Akemi Yamashita,Takahiro Kimura,Yuko Uehara,Seiichiro Yoshikawa,Tadaaki Minowa,Akio Mizushima,Hiromitsu Takano

doi:10.1186/s12885-021-08177-w

Abstract

BackgroundAndrogen deprivation therapy (ADT) is the effective treating prostate cancer but is often accompanied by cancer treatment-induced bone loss (CTIBL), which impairs the patient’s quality of life. In patients with nonmetastatic castration-sensitive prostate cancer (M0CSPC) who already have osteoporosis before starting ADT, appropriate bone-modifying agent intervention must be performed in parallel, as the patient has a high risk of future fracture. However, little is known about therapeutic interventions aimed at preventing the progression of CTIBL and new fractures. The present study explored the effect of once-yearly zoledronic acid 5 mg (ZOL 5 mg) on bone mineral density (BMD) and new vertebral fractures (VFs) in M0CSPC patients with coexisting osteoporosis before starting ADT.MethodsWe conducted a retrospective, multi-institutional, cohort study involving 42 M0CSPC patients with osteoporosis who had undergone ADT with/without a single intravenous infusion of ZOL 5 mg at the start of ADT (ZOL 5 mg group, n = 26; control group, n = 16). The association of the ZOL 5 mg with changes in the BMD from baseline to 12 months and the incidence of VFs were evaluated.ResultsPrevalent VFs were found in 47.6% of all patients at baseline. ZOL 5 mg significantly increased the lumbar spine BMD (LS-BMD) (mean rate of change: + 4.02%, p < 0.0001) and significantly decreased the TRACP-5b (mean rate of change: − 52.1%, p < 0.0001) at 12 months after starting ADT. Incident VFs were identified in 19.0% of all patients at 12 months after starting ADT. After adjusting for the age, BMI, and changes in the LS-BMD, ZOL 5 mg was not significantly associated with incident VFs (odds ratio 0.66, 95% confidence interval 0.04–11.3, p = 0.7774).ConclusionZOL 5 mg significantly increased the LS-BMD 12 months after starting ADT, and our short-term results showed that ZOL 5 mg was not significantly correlated with the suppression of incident vertebral fractures.

Highlights

Androgen deprivation therapy (ADT) is the effective treating prostate cancer but is often accompanied by cancer treatment-induced bone loss (CTIBL), which impairs the patient’s quality of life
If patients scheduled to undergo ADT already have osteoporosis, appropriate bone-modifying agent (BMA) interventions should be performed in parallel, as these patients are at an increased risk of fracture [3]
No significant differences were observed between the groups in the baseline age, body height, weight, body mass index (BMI), serum creatinine levels, estimated glomerular filtration rate (eGFR), TRACP-5b, prostate-specific antigen (PSA), lumbar spine bone mineral density (BMD) (LS-BMD), femoral neck BMD (FN-BMD) or prevalence of diabetes mellitus, hypertension or dyslipidemia

Summary

Introduction

Androgen deprivation therapy (ADT) is the effective treating prostate cancer but is often accompanied by cancer treatment-induced bone loss (CTIBL), which impairs the patient’s quality of life. In patients with nonmetastatic castration-sensitive prostate cancer (M0CSPC) who already have osteoporosis before starting ADT, appropriate bone-modifying agent intervention must be performed in parallel, as the patient has a high risk of future fracture. Androgen deprivation therapy (ADT), which forms the core of prostate cancer treatment, reduces the overall bone strength by decreasing the bone mineral density (BMD) and the bone quality [1, 2]. If patients scheduled to undergo ADT already have osteoporosis, appropriate bone-modifying agent (BMA) interventions should be performed in parallel, as these patients are at an increased risk of fracture [3]

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Discussion

Conclusion