Preventing Osteoporosis in Men Taking Androgen Deprivation Therapy for Prostate Cancer: A Systematic Review and Meta-Analysis

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. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.