Systematic review and network meta-analysis on the relative efficacy of osteoporotic medications: men with prostate cancer on continuous androgen-deprivation therapy to reduce risk of fragility fractures

BJU Int. 2018 Jan;121(1):17-28. doi: 10.1111/bju.14015. Epub 2017 Oct 15.


Androgen-deprivation therapy (ADT) is an effective treatment for men with advanced prostate cancer, but loss of bone mineral density (BMD) is a major risk factor for fractures. This review compared the efficacy of available treatments to provide prescribing guidance to healthcare professionals. This is the first review to compare the effectiveness of different osteoporotic treatments (bisphosphonates, denosumab, toremifene, and raloxifene) on BMD in patients with non-metastatic prostate cancer on ADT using network meta-analysis. Results suggest that all evaluated treatments are effective in improving BMD compared to placebo. Zoledronic acid (ZA) was found to have a greater improvement in BMD compared to other active treatments at all three studied sites, except for risedronate, which had better BMD improvement compared to ZA at the femoral neck site in one small study. Our study did not identify evidence that one drug is unequivocally more effective than another. All drugs appeared to be effective in reducing the rate of bone loss. Healthcare professionals should also consider patient preference, costs, and local availability as part of the decision process.

Keywords: #PCSM; #ProstateCancer; androgen-deprivation therapy; bone mineral density; fracture prevention; meta-analysis.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Absorptiometry, Photon / methods
  • Aged
  • Androgen Antagonists / adverse effects*
  • Androgen Antagonists / therapeutic use
  • Bone Density / drug effects
  • Bone Density / physiology
  • Bone Density Conservation Agents / administration & dosage
  • Diphosphonates / administration & dosage*
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Invasiveness / pathology
  • Neoplasm Staging
  • Network Meta-Analysis
  • Osteoporosis / chemically induced
  • Osteoporosis / diagnostic imaging
  • Osteoporosis / drug therapy*
  • Osteoporotic Fractures / prevention & control*
  • Prognosis
  • Prostatic Neoplasms / drug therapy*
  • Prostatic Neoplasms / mortality
  • Prostatic Neoplasms / pathology
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Treatment Outcome


  • Androgen Antagonists
  • Bone Density Conservation Agents
  • Diphosphonates