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

• Published in: BMC cancer Vol. 21; no. 1; p. 422
• Main Authors: Watanabe, Daisuke, Kimura, Takahiro, Watanabe, Ken, Takano, Hiromitsu, Uehara, Yuko, Minowa, Tadaaki, Yamashita, Akemi, Yoshikawa, Seiichiro, Mizushima, Akio
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 17-04-2021; BioMed Central; BMC
• Subjects: Acid phosphatase (tartrate-resistant); Age; Aged; Aged, 80 and over; Androgens; Body mass index; Bone cancer; Bone density; Bone Density - drug effects; Bone Density Conservation Agents - administration & dosage; Bone loss; Bone mineral density; Bones; Cancer therapies; Castration; Comorbidity; Creatinine; Density; Diabetes; Dosage and administration; Drug Administration Schedule; Drug therapy; Fractures; Hospitals; Humans; Hypertension; Intravenous administration; Japan - epidemiology; Kidney Function Tests; Male; Middle Aged; Osteoporosis; Osteoporosis - epidemiology; Osteoporosis - etiology; Patient outcomes; Patients; Prostate cancer; Prostatic Neoplasms - epidemiology; Prostatic Neoplasms - pathology; Public Health Surveillance; Quality of life; Regression analysis; Retrospective Studies; Risk Factors; Spinal Fractures - epidemiology; Spinal Fractures - etiology; Spinal Fractures - prevention & control; Spine; Spine (lumbar); Therapeutic applications; Vertebrae; Zoledronic acid; Zoledronic Acid - administration & dosage; Japan; United States > US
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-021-08177-w

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. 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.
We 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.
Prevalent 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).
ZOL 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.