The Role of Bone-Targeted Therapies

Clinical Brief: Bone-Targeted Therapies in Advanced Prostate Cancer

Main Discussion Topics

• Therapeutic Goals: Prevention of skeletal-related events and protection of bone health during androgen deprivation therapy (ADT)
• Evidence Base: Limited guideline support for denosumab in hormone-sensitive disease vs established role in castration-resistant setting
• Zoledronic Acid: Recent STAMPEDE trial data showing reduced fracture risk, though not yet incorporated into guidelines
• Supportive Measures: Calcium and vitamin D supplementation, resistance exercise, and bone density monitoring

Key Points for Physicians

• All patients on ADT should receive calcium and vitamin D3 supplementation
• Vitamin K2 may help activate proteins binding calcium to bones (contraindicated with anticoagulants)
• Resistance exercises should be recommended as physical condition permits
• Regular monitoring of bone density, calcium levels, and renal function is essential

Notable Insights

While denosumab and zoledronic acid have established roles in castration-resistant disease, emerging evidence suggests potential benefits in hormone-sensitive settings that may influence future guideline recommendations.

Clinical Significance

Comprehensive bone health management is an essential component of prostate cancer care, requiring attention to both pharmacologic interventions and supportive measures to reduce fracture risk and maintain quality of life.