Opinion
Video
The Role of Bone-Targeted Therapies
Author(s):
Paul E. Dato, MD, discusses how bone-targeted therapies play an important supportive role in advanced prostate cancer, with recommendations for calcium and vitamin D supplementation, vitamin K2 consideration, resistance exercises, and regular monitoring for all patients on ADT.
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.
