Preventing osteoporosis in men taking androgen deprivation therapy for prostate cancer: a systematic review and meta-analysis

Joseph Sargon Joseph, Vincent Lam, Manish I. Patel

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

Context: Advanced prostate cancer (PCa) is treated with androgen deprivation therapy (ADT) which results in loss of bone mineral density (BMD) and osteoporosis. Objective: To perform a systematic review and meta-analysis of evidence to determine the most effective methods of preventing BMD loss in patients with PCa treated with ADT. Evidence acquisition: A systematic search of the Medline, Embase, and EBM Reviews databases was conducted on July 20, 2016 to identify studies on men who received an intervention to prevent osteoporosis after diagnosis of PCa and treatment with ADT. The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed and the studies found were critically appraised. Evidence synthesis: Twenty-five studies were included in the review and 13 had quantitative data sufficient for meta-analysis of BMD loss. Bisphosphonates led to a significant improvement in areas assessed: the mean difference was 7.09% (95% confidence interval [CI] 5.05-9.13%; p<0.00001) for lumbar BMD, 4.63% (95% CI 0.87-8.4; p=0.02) for femoral neck BMD, and 3.16% (95% CI 0.09-6.23%; p=0.04) for total hip BMD. Selective estrogen receptor modulators (SERMs) were less effective, exercise studies had inconsistent effects, and denosumab could not be quantitatively analyzed. Conclusions: Bisphosphonates and denosumab are effective treatments in preventing BMD loss in men with PCa taking ADT. SERMs are a less effective alternative. Exercise programs are insufficient in isolation but have a role as an adjunct for holistic care. Patient summary: In this review we determined the best option for preventing osteoporosis in men with prostate cancer being treated with androgen deprivation therapy. We found that bisphosphonates, denosumab, and selective estrogen receptor modulators (SERMs) were effective, but exercise was not useful in isolation. We conclude that bisphosphonates, denosumab, or SERMs should be used and exercise encouraged.

LanguageEnglish
Pages551-561
Number of pages11
JournalEuropean Urology Oncology
Volume2
Issue number5
DOIs
Publication statusPublished - 1 Sep 2019
Externally publishedYes

Fingerprint

Bone Density
Androgens
Osteoporosis
Meta-Analysis
Prostatic Neoplasms
Selective Estrogen Receptor Modulators
Diphosphonates
Exercise
Confidence Intervals
Therapeutics
Pelvic Bones
Femur Neck
Databases
Denosumab

Keywords

  • Androgen deprivation therapy
  • Bone mineral density
  • Meta-analysis
  • Osteoporosis
  • Prostate cancer

Cite this

@article{b3d8409c4ada48dba86f03d0b1067141,
title = "Preventing osteoporosis in men taking androgen deprivation therapy for prostate cancer: a systematic review and meta-analysis",
abstract = "Context: Advanced prostate cancer (PCa) is treated with androgen deprivation therapy (ADT) which results in loss of bone mineral density (BMD) and osteoporosis. Objective: To perform a systematic review and meta-analysis of evidence to determine the most effective methods of preventing BMD loss in patients with PCa treated with ADT. Evidence acquisition: A systematic search of the Medline, Embase, and EBM Reviews databases was conducted on July 20, 2016 to identify studies on men who received an intervention to prevent osteoporosis after diagnosis of PCa and treatment with ADT. The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed and the studies found were critically appraised. Evidence synthesis: Twenty-five studies were included in the review and 13 had quantitative data sufficient for meta-analysis of BMD loss. Bisphosphonates led to a significant improvement in areas assessed: the mean difference was 7.09{\%} (95{\%} confidence interval [CI] 5.05-9.13{\%}; p<0.00001) for lumbar BMD, 4.63{\%} (95{\%} CI 0.87-8.4; p=0.02) for femoral neck BMD, and 3.16{\%} (95{\%} CI 0.09-6.23{\%}; p=0.04) for total hip BMD. Selective estrogen receptor modulators (SERMs) were less effective, exercise studies had inconsistent effects, and denosumab could not be quantitatively analyzed. Conclusions: Bisphosphonates and denosumab are effective treatments in preventing BMD loss in men with PCa taking ADT. SERMs are a less effective alternative. Exercise programs are insufficient in isolation but have a role as an adjunct for holistic care. Patient summary: In this review we determined the best option for preventing osteoporosis in men with prostate cancer being treated with androgen deprivation therapy. We found that bisphosphonates, denosumab, and selective estrogen receptor modulators (SERMs) were effective, but exercise was not useful in isolation. We conclude that bisphosphonates, denosumab, or SERMs should be used and exercise encouraged.",
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Preventing osteoporosis in men taking androgen deprivation therapy for prostate cancer : a systematic review and meta-analysis. / Joseph, Joseph Sargon; Lam, Vincent; Patel, Manish I.

In: European Urology Oncology, Vol. 2, No. 5, 01.09.2019, p. 551-561.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Preventing osteoporosis in men taking androgen deprivation therapy for prostate cancer

T2 - European Urology Oncology

AU - Joseph, Joseph Sargon

AU - Lam, Vincent

AU - Patel, Manish I.

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Y1 - 2019/9/1

N2 - Context: Advanced prostate cancer (PCa) is treated with androgen deprivation therapy (ADT) which results in loss of bone mineral density (BMD) and osteoporosis. Objective: To perform a systematic review and meta-analysis of evidence to determine the most effective methods of preventing BMD loss in patients with PCa treated with ADT. Evidence acquisition: A systematic search of the Medline, Embase, and EBM Reviews databases was conducted on July 20, 2016 to identify studies on men who received an intervention to prevent osteoporosis after diagnosis of PCa and treatment with ADT. The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed and the studies found were critically appraised. Evidence synthesis: Twenty-five studies were included in the review and 13 had quantitative data sufficient for meta-analysis of BMD loss. Bisphosphonates led to a significant improvement in areas assessed: the mean difference was 7.09% (95% confidence interval [CI] 5.05-9.13%; p<0.00001) for lumbar BMD, 4.63% (95% CI 0.87-8.4; p=0.02) for femoral neck BMD, and 3.16% (95% CI 0.09-6.23%; p=0.04) for total hip BMD. Selective estrogen receptor modulators (SERMs) were less effective, exercise studies had inconsistent effects, and denosumab could not be quantitatively analyzed. Conclusions: Bisphosphonates and denosumab are effective treatments in preventing BMD loss in men with PCa taking ADT. SERMs are a less effective alternative. Exercise programs are insufficient in isolation but have a role as an adjunct for holistic care. Patient summary: In this review we determined the best option for preventing osteoporosis in men with prostate cancer being treated with androgen deprivation therapy. We found that bisphosphonates, denosumab, and selective estrogen receptor modulators (SERMs) were effective, but exercise was not useful in isolation. We conclude that bisphosphonates, denosumab, or SERMs should be used and exercise encouraged.

AB - Context: Advanced prostate cancer (PCa) is treated with androgen deprivation therapy (ADT) which results in loss of bone mineral density (BMD) and osteoporosis. Objective: To perform a systematic review and meta-analysis of evidence to determine the most effective methods of preventing BMD loss in patients with PCa treated with ADT. Evidence acquisition: A systematic search of the Medline, Embase, and EBM Reviews databases was conducted on July 20, 2016 to identify studies on men who received an intervention to prevent osteoporosis after diagnosis of PCa and treatment with ADT. The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed and the studies found were critically appraised. Evidence synthesis: Twenty-five studies were included in the review and 13 had quantitative data sufficient for meta-analysis of BMD loss. Bisphosphonates led to a significant improvement in areas assessed: the mean difference was 7.09% (95% confidence interval [CI] 5.05-9.13%; p<0.00001) for lumbar BMD, 4.63% (95% CI 0.87-8.4; p=0.02) for femoral neck BMD, and 3.16% (95% CI 0.09-6.23%; p=0.04) for total hip BMD. Selective estrogen receptor modulators (SERMs) were less effective, exercise studies had inconsistent effects, and denosumab could not be quantitatively analyzed. Conclusions: Bisphosphonates and denosumab are effective treatments in preventing BMD loss in men with PCa taking ADT. SERMs are a less effective alternative. Exercise programs are insufficient in isolation but have a role as an adjunct for holistic care. Patient summary: In this review we determined the best option for preventing osteoporosis in men with prostate cancer being treated with androgen deprivation therapy. We found that bisphosphonates, denosumab, and selective estrogen receptor modulators (SERMs) were effective, but exercise was not useful in isolation. We conclude that bisphosphonates, denosumab, or SERMs should be used and exercise encouraged.

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KW - Meta-analysis

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KW - Prostate cancer

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