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Alendronate improves bone density and reduces bone turnover in men undergoing androgen-deprivation therapy (ADT) for localized prostate cancer, according to a report.

Alendronate improves bone density and reduces bone turnover in men undergoing androgen-deprivation therapy (ADT) for localized prostate cancer, according to a report in the September 20th Journal of Clinical Oncology.

Men undergoing ADT for prostate cancer experience significant bone loss compared with their counterparts who are not receiving ADT, the authors explain, and previous research shows that alendronate can prevent bone loss in these men for up to one year.

Dr. Susan L. Greenspan from University of Pittsburgh in Pennsylvania and colleagues examined changes in bone mineral density and turnover in a crossover study of continuous alendronate 70 mg once weekly; discontinuous alendronate; or placebo. All of the 112 men received ADT for prostate cancer.

After two years, men in the continuous alendronate group had the greatest increases in bone mineral density at the spine, total hip, and femoral neck, the authors report. Men in the placebo groups had smaller increases at the spine and insignificant changes at the total hip and femoral neck.

Bone mineral density at the one-third distal radius and total radius decreased, except for the subjects who were on continuous alendronate for the entire two-year period.

Biochemical markers of bone turnover decreased to a similar extent in all treatment groups at two years, the investigators report. Men who had been receiving ADT for more than 36 months before beginning alendronate treatment experienced significantly less of a gain in bone mineral density than did men who had been receiving ADT for less than 36 months.

"Improvements in bone mineral density in men with prostate cancer on androgen deprivation are greatest in men who continue to receive alendronate therapy," the authors conclude. "Furthermore, delay in treatment is detrimental to skeletal integrity."

"In men with low bone mass or osteoporosis, once-weekly oral therapy with alendronate should be considered early and continued for at least two years in men with prostate cancer who are receiving ADT to gain maximum benefit to the skeleton," they advise.

J Clin Oncol 2008;26:4426-4434