Bisphosphonates for Osteoporosis in Nonmetastatic Prostate Cancer Patients Receiving Androgen-deprivation Therapy: A Systematic Review and Meta-analysis

This systematic review was conducted to assess the efficacy and safety of bisphosphonates for preventionand treatment of osteopenia or osteoporosis in men with non-metastatic prostate cancer receiving androgendeprivationtherapy. We searched for randomised controlled trials (RCTs) of bisphosphonates compared withplacebo from Pubmed, Embase, the Cochrane Library, and ISI - Science Citation Index. Meta-analyses of prespecifiedoutcomes (bone mineral density, fractures, and adverse events) were performed using Review Manager.Ten RCTs with a total patient population of 1,017 were identified. There was generally more improvement in bonemineral density of the lumbar spine for patients who received bisphosphonate treatment than placebo or othermedical treatment at 12 months (WMD 6.02,95%CI 5.39 to 6.65). Similar effects were also observed for totalhip, trochanter or femoral neck bone mineral density. However, there was no significant reduction in fractures.Fever and gastrointestinal symptoms were the most common adverse events (10.4% vs. 1.2%; 0.10% vs. 0.03%).Currently, our meta-analysis suggested that oral and intravenous bisphosphonates caused a rapid increasein spine and hip or femoral BMD in non-metastatic prostate cancer patients receiving androgen-deprivationtherapy. Fever and gastrointestinal symptoms were common with the use of bisphosphonates. These short-termtrials (maximum of 12 months) did not show fracture reduction. In future, more efficient performance of higherquality, more rigorous, large sample, long-term randomised controlled trials (>12 months) are needed whereoutcomes are detailed.