Comparing the Efficacy and Safety of Denosumab with Bisphosphonates in Increasing Bone Mineral Density in Patients with Prostate Cancer and Breast Cancer on Antihormonal Treatment

Abstract

Osteoporosis is a common condition prevalent in both sexes that can be primary and secondary. Secondary osteoporosis may occur in cancer patients undergoing antihormonal treatment, leading to an increased risk of fractures. Androgen deprivation therapy (ADT) in patients with prostate cancer and aromatase inhibitors (AI) in patients with breast cancer can drastically increase the risk of osteoporosis. Bisphosphonates are one of the key medications in managing these patients and are widely prescribed. A monoclonal antibody called denosumab, which is a relatively new treatment option, is also used in this population group. To conduct a detailed comparison of these groups, we performed a thorough literature search using Pubmed and Google Scholar to extract data in the form of research papers/clinical trials. A total of 18 research papers were extracted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and other inclusion and exclusion criteria. Seven of these papers were based on randomized controlled trials (RCTs) comparing denosumab with either placebo or bisphosphonates in patients with breast cancer and prostate cancer. Two metaanalyses comparing the safety and efficacy of both these drugs in this population group were also included. Denosumab was found to significantly increase bone mineral density (BMD) for up to two years and showed better results than bisphosphonates, while both had a comparable safety profile. More trials should be conducted in patients with prostate cancer or breast cancer on ADT or AI therapy, respectively, for longer durations to assess the long-term safety of these drugs in this population.

Cancer Treatment–Induced Bone Loss and Role of Denosumab in Nonmetastatic Prostate Cancer: A Narrative Review

“…40 Oral bisphosphonates require that patients should not lie down; hence, denosumab can be a good option in patients who are unable to sit or stand. 41 Denosumab, in addition to improving the BMD, also reduces the incidence of new radiographic vertebral fractures, whereas bisphosphonates increase the BMD but a meta-analysis concluded that evidence was not sufficiently powered to detect fracture reduction. 42…”

Randomized Double-Blind Comparative Study of First Global Denosumab Biosimilar in Oncology

“…8 Bisphosphonates and denosumab reduce the incidence of bone complications in patients with bone metastases from solid tumors, with denosumab showing superiority compared with zoledronic acid in patients with breast and prostate cancer. 9 The subcutaneous administration and its efficacy make it an attractive first-line therapy and reasonable alternative to parenteral bisphosphonates, in particular in patients with advanced renal insufficiency. Denosumab has become a novel therapeutic option for the treatment of benign and malignant bone diseases that combines efficacy with a high degree of safety and comfortable administration.…”