January 2020 Bone Health Alert

Reports have revealed that weight-bearing exercise
can help to slow bone loss...continue reading

A very important, but often overlooked, aspect of treating Prostate Cancer in patients is the management of bone health. Patients receiving androgen deprivation (hormone) therapy to treat their disease are at an increased risk to develop osteoporosis and experience fractures and other skeletal related
events from weakened bones.

What leads to Bone Loss in Prostate Cancer Patients?

When Prostate Cancer begins to spread in patients (metastatic) the most common place it is seen is in the bones. This can weaken bones and lead to pain in the lower back and joints of effected patients that may lower quality of life.

In addition, hormone therapies have bone loss, fractures and joint pain as common side effects. This is because these therapies work by blocking testosterone production in the body, which is an important factor for bone health. This can lead to a decrease in bone density in males receiving these treatments and as a result take them longer to recover from bone fractures than other men.

• Radiation and chemotherapy may also reduce patient bone health.
  

Patients may also be prescribed preventative treatments by their doctors for bone health including:

• Calcium supplements
  
• Vitamin D supplements
  
• Regular exercise and dieting along with limiting alcohol and smoking consumption is also recommended.
  

Recommended treatments for bone health management to reduce the risk of complications in prostate cancer patients

• Denosumab (Xgeva)
  • Administered via Injection in the upper arm, thigh or abdomen
    
• Zoledronic acid (Zometa)
  
  • Administered via intravenous injection
    

Studies show that Denosumab (Xgeva) demonstrated a longer period of time before patients experienced their first skeletal event than those taking zoledronic acid (20.7 months for Xgeva vs. 17.1 months for zoledronic acid, an 18% risk reduction for patients).

      Patients taking zoledronic acid also experienced higher complications related to kidney failure (African American patients are at highest risk for kidney failure with a 3-times higher risk and represent 35% of all patients in the US on dialysis)

* Treatment with denosumab (Xgeva) is listed as preferred over zoledronic acid by the National Comprehensive Cancer Network (NCCN) Prostate Cancer Treatment Guidelines.

A potential bone complication for Prostate Cancer patients being treated with Xgeva or Zometa is known as osteonecrosis of the jaw. This condition can cause the jaw bone to deteriorate and lead to a number of dental issues. It is recommended for patients to see a dentist and have any work done on their teeth before starting these treatments.

This side effect occurs in less than 20% of prostate cancer patients.