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Alendronate combats skeletal side effects of antiandrogen therapy

BMJ 2007; 334 doi: (Published 29 March 2007) Cite this as: BMJ 2007;334:661

Antiandrogen therapy may be an effective treatment for prostate cancer, but it has a detrimental effect on bone mineral density, which leads to osteoporosis and fractures. Men using gonadotrophin releasing hormone agonists, antiandrogens, or both, should be carefully assessed and may benefit from additional treatment with alendronate, write researchers. A randomised trial showed that the bisphosphonate commonly given to post-menopausal women also worked for men.

The men, who already had low bone mass, took oral alendronate 70 mg or placebo once a week for a year. All participants also took calcium and vitamin D supplements. By the end of the study men treated with alendronate had higher bone mineral density and lower bone turnover than controls. The differences were clinically and statistically significant, and they were most evident at the spine and hip. Controls continued to lose bone mineral density at the spine, femoral neck, and distal radius throughout the study.

It's still unclear whether these benefits will translate into fewer osteoporotic fractures in this vulnerable population of men. This trial was too small (n=112) and underpowered to find out.


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