Alendronate improves BMD in men on anti-androgen therapy

NEW YORK (Reuters Health) - In men on androgen-deprivation therapy (ADT) who have severe osteopenia or osteoporosis, alendronate improves bone mineral density (BMD) and decreases fracture risk, report clinicians from Spain in the December issue of BJU International.

Dr. Jacques Planas, from Hospital Vall d'Hebron, Barcelona and colleagues studied changes in bone mass and fracture risk in men with prostate cancer on ADT who had basal T-scores of -2.0 or more.

Thirty-one men "were treated...with once-weekly 70 mg oral alendronate plus 1000 mg calcium and 800 IU of vitamin D." Findings in this group were compared with historical data from 30 similar men who were not treated with a bisphosphonate.

At one year, the alendronate group had a significant increase over baseline in mean BMD at the lumbar spine (p < 0.001) and femoral neck (p = 0.03). The mean BMD at the total hip also increased after one year of treatment but not to a statistically significant extent.

In contrast, control patients had a significant loss in mean BMD at the total hip (p = 0.03), an insignificant increase at the lumbar spine, and an insignificant loss at the femoral neck, they report.

Specifically, according to the article, "the mean BMD was significantly improved at the three locations in patients treated with alendronate compared to patients in the control group," with differences at the lumbar spine, femoral neck and total hip of 0.05 versus 0.01 (p = 0.001), 0.01 vs -0.002 (p = 0.04), and 0.01 vs -0.01 (p = 0.001) g/cm2, respectively.

The alendronate group also had a significant decrease in the fracture risk at the femoral neck, by -0.54 (p = 0.04), the investigators report.

"Because BMD is inversely related to the risk of fracture risk in men with prostrate cancer, maintaining or increasing the BMD in patients receiving ADT is likely to lower the risk and incidence of fragility fractures," Dr. Planas and colleagues note in their report.

"Nevertheless, studies evaluating bisphosphonates for preventing fractures are needed in these patients," they conclude.

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