This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Greenspan, S. L. Articles by Resnick, N. M. Search for Related Content PubMed PubMed Citation Articles by Greenspan, S. L. Articles by Resnick, N. M. Related Articles Related Editorial Social Bookmarking                            What's this?

Skeletal Health After Continuation, Withdrawal, or Delay of Alendronate in Men With Prostate Cancer Undergoing Androgen-Deprivation Therapy

Susan L. Greenspan, Joel B. Nelson, Donald L. Trump, Julie M. Wagner, Megan E. Miller, Subashan Perera, Neil M. Resnick

From the Divisions of Geriatric Medicine and Endocrinology and Metabolism, Department of Medicine; Departments of Urology and Biostatistics, University of Pittsburgh, Pittsburgh, PA; and the Department of Medicine and Therapeutics Program, Roswell Park Cancer Institute, Buffalo, NY

Corresponding author: Susan L. Greenspan, MD, University of Pittsburgh, 3471 5th Ave, Suite 1110, Pittsburgh, PA 15213-3221; e-mail: greenspans{at}dom.pitt.edu

Purpose Androgen-deprivation therapy (ADT) for prostate cancer is associated with bone loss and osteoporotic fractures. Our objective was to examine changes in bone density and turnover with sustained, discontinued, or delayed oral bisphosphonate therapy in men receiving ADT.

Patients and Methods A total of 112 men with nonmetastatic prostate cancer receiving ADT were randomly assigned to alendronate 70 mg once weekly or placebo in a double-blind, partial-crossover trial with a second random assignment at year 2 for those who initially received active therapy. Outcomes included bone mineral density and bone turnover markers.

Results Men initially randomly assigned to alendronate and randomly reassigned at year 2 to continue had additional bone density gains at the spine (mean, 2.3% ± 0.7) and hip (mean, 1.3% ± 0.5%; both P < .01); those randomly assigned to placebo in year 2 maintained density at the spine and hip but lost (mean, –1.9% ± 0.6%; P < .01) at the forearm. Patients randomly assigned to begin alendronate in year 2 experienced improvements in bone mass at the spine and hip, but experienced less of an increase compared with those who initiated alendronate at baseline. Men receiving alendronate for 2 years experienced a mean 6.7% (± 1.2%) increase at the spine and a 3.2% (± 1.5%) at the hip (both P < .05). Bone turnover remained suppressed.

Conclusion Among men with nonmetastatic prostate cancer receiving ADT, once-weekly alendronate improves bone density and decreases turnover. A second year of alendronate provides additional skeletal benefit, whereas discontinuation results in bone loss and increased bone turnover. Delay in bisphosphonate therapy appears detrimental to bone health.

Supported in part by the National Institutes of Health (R01 DK61536), the National Institute of Diabetes and Digestive and Kidney Diseases (K24 DK062895 [GenBank] ), and the Clinical and Translational Research Center of the University of Pittsburgh by the National Institutes of Health and the National Center for Research Resources (M01-RR00056). Merck & Co provided alendronate and matching placebo. GlaxoSmithKline provided calcium and vitamin D supplements.

Presented in part at the 28th Annual Meeting of the American Society of Bone and Mineral Research, September 15-19, 2006, Philadelphia, PA.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Clinical trial information can be found for the following: NCT00048841 [ClinicalTrials.gov] .

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Editorial

• Osteoporosis in Men With Prostate Cancer: Now for the Fracture Data
  Matthew R. Smith
  JCO 2008 26: 4371-4372 [Full Text]

This article has been cited by other articles:

				S. Vignot and D. Khayat A Step in the Journey of Denosumab From Bone-Targeted Therapy to Seed- and Soil-Targeted Therapy J. Clin. Oncol., April 1, 2009; 27(10): 1534 - 1536. [Full Text] [PDF]

				C. S. Colon-Emeric Fracture Prevention in Frail Older Adults: Why, When and How IBMS BoneKEy, November 1, 2008; 5(11): 426 - 435. [Abstract] [Full Text] [PDF]

				M. R. Smith Osteoporosis in Men With Prostate Cancer: Now for the Fracture Data J. Clin. Oncol., September 20, 2008; 26(27): 4371 - 4372. [Full Text] [PDF]