EFFECTIVENESS OF BISPHOSPHONATES AND DENOSUMAB ON RISK OF VERTEBRAL FRACTURES IN PROSTATE CANCER PATIENTS UNDER ANDROGEN-DEPRIVATION THERAPIES: A REAL-WORLD PROSPECTIVE STUDY.
Alberto Piasentier, Maria Francesca Birtolo, Bianca Turci, Walter Vena, Alessandro Fanti, Emanuela Morenghi, Lucrezia M S Gentile, Luca Balzarini, Antonio C Bossi, Alfredo Berruti, Giovanni Lughezzani, Ciro Franzese, Fabio De Vincenzo, Marta Scorsetti, Paolo A Zucali, Andrea G Lania, Gherardo Mazziotti
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Abstract
Objectives: This prospective study investigated the real-world effectiveness of bisphosphonates and denosumab in reducing vertebral fractures (VFs) risk induced by androgen-deprivation therapies (ADTs).
Methods: 226 consecutive men (mean age 74.8±6.9 years) undergoing ADT were evaluated for morphometric VFs at baseline and after 26.1±10.7 months of follow-up (range 18-64). Following enrolment, 153 patients commenced bisphosphonates (98 cases) or denosumab (55 cases), while 73 patients (32.3%) received only vitamin D and calcium supplementation. As additional control group, we enrolled 62 consecutive men (mean age 74.9±7.2 years) under chronic ADTs who had never been either evaluated or treated for skeletal fragility before study entry.
Results: Incident VFs were found in 16/226 (7.1%) patients enrolled in the prospective study and in 18/62 (29.0%) control subjects (p<0.001). The risk of VFs was significantly lower in patients treated with bone active drugs as compared to those treated with vitamin D (hazard ratio 0.26, 95% confidence interval 0.09-0.73; p=0.01), without significant difference between denosumab and bisphosphonates treatment (p=0.423), although denosumab treated patients had lower BMD, higher C-terminal telopeptide of type I collagen (CTX), and more prevalent VFs. Noteworthy, incident VFs were significantly lower in patients receiving vitamin D with calcium as compared to those subjects under chronic ADT who had not been ever evaluated and treated for skeletal fragility prior to the study (12.3% vs. 29.0%; p=0.016).
Conclusions: In real-world clinical practice, bisphosphonates or denosumab might be effective in reducing risk of VFs related to ADTs.
期刊介绍：
Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.
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