Risk of bone fractures in patients with prostate cancer treated with maximal androgen blockade therapy: a systematic literature review and meta-analysis.
Isabella Saporita, Mariangela Calabrese, Federica Maria Carfi et al.
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In 30 seconds
This systematic review and meta-analysis examined fracture risk with maximal androgen blockade (MAB)—androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor—versus ADT alone in patients with prostate cancer. Seventeen studies included 16,162 patients: 9,240 received MAB and 6,922 received ADT alone. Each type of ADT plus ARPI was associated with a statistically significant increase in fractures compared with ADT alone, with pooled odds ratios ranging from 1.5 to 2.4. The magnitude of risk did not differ among ARPIs.
Key findings
- Across 17 studies and 16,162 patients, MAB was associated with higher fracture risk than ADT alone.
- Pooled odds ratios for fracture with the different ADT-plus-ARPI regimens ranged from 1.5 to 2.4 versus ADT alone.
- The magnitude of fracture risk did not differ among ARPIs.
- Only 7 studies reported how many patients received a bone-protecting agent.
Why it matters
Fracture risk is relevant when weighing the benefits and harms of intensified androgen suppression, particularly where MAB is used long term. The findings indicate that the increased risk was seen across the ARPI types assessed, while limited reporting of bone-protecting agent use leaves uncertainty about how bone protection was applied in the included studies.
What to keep in mind
Only 7 studies reported bone-protecting agent use, limiting assessment of its role in fracture risk.