Risedronate prevents bone loss in patients on hormone therapy

A new study has shown that the generically available, oral, bisphosphonate risedronate (Actonel) can prevent bone loss and related effects in patients receiving hormonal therapy for prostate cancer.

Taxel et al. carried out a small, 6-month-long, randomized, double-blind, placebo-controlled trial in 40 men aged 55 years or older, and who were receiving LHRH agonist for locally advanced prostate cancer. The patients’ bone mineral density (BMD) was measured every 6 months at three sites: the lumbar spine, the femoral neck, and the hip. In addition, the investigators assessed the levels of three bone turnover markers (N-telopeptide, serum C-telopeptide, and procollagen peptide), 25-hydroxy vitamin D, and intact parathyroid hormone at baseline and at 6 months.

Results of the trial showed the following:

  • After 6 months of LHRH agonist therapy, the control group had a significant decline at the spine and hip BMD sites.
  • Also at 6 months of LHRH therapy, the risedronate group had no bone loss at the hip and an increase at the lumber spine.
  • Markers of bone turnover were increased significantly in the control group but unchanged in the risedronate group.

The authors conclude that LHRH agonist treatment for locally advanced prostate cancer produces increased bone turnover and rapid bone loss within the initial 6 months of therapy, and this can be prevented by weekly risedronate treatment.

Why is this study of any importance, you might ask? Basically because unlike zoledronate, risedronate is an oral drug that can be taken easily at a daily dose of 5 mg (35 mg/week). In addition, because it is generically available, it is a great deal more cost-effective that zoledronate.

It would be helpful to see data from a larger study that could replicate the findings of this study by Taxel and colleagues. However, this may be a situation in which physicians and patients have to make the best decisions they can with the available data. It is well understood that it is wise for patients on long-term hormone therapy to take a bisphosphonate to manage risk for bone loss. Many patients have not done so in the past — for a variety of reasons that include cost and the difficulty of monthly injections of zoledronate. If these problems can be avoided by using risedronate, so much the better.

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