Men's Osteoporosis Support Group

Atelvia now FDA approved for osteoporosis; 3-D external beam radiotherapy for prostate cancer; Denosumab prevents fractures

Ateliva, delayed-release risedronate (Actonel), has FDA approval for osteoporosis treatment. This is a special formulation of risedronate that allows people to eat and take the medication at the same time. Formerly, all the bisphosphonates had to be taken on an empty stomach with nothing to eat for at least one-half hour afterward. See the Atelvia website or docguide.com article for more details. Note that it is only approved for treatment of osteoporosis in women, but it could be given as an off-label medication to men.

Cancer. 2011 Mar 16. doi: 10.1002/cncr.25994. [Epub ahead of print]. Three-dimensional external beam radiotherapy for prostate cancer increases the risk of hip fracture. Elliott SP and others. PMID: 21412999. This study involved 45,662 men older than 66 years who had been diagnosed with prostate cancer. The goal was to see if pelvic external beam radiotherapy (EBRT) increased hip fracture risk in the men as it had been shown to do in women. The results showed that is true with 76% increased hip fracture risk with use of EBRT alone. The authors concluded, “In men with prostate cancer, pelvic 3-D conformal EBRT was associated with a 76% increased risk of hip fracture. This risk was slightly increased further by the addition of short-course AST [androgen suppression therapy] to EBRT.”

Editor's comments. Since there is high morbidity and mortality related to hip fracture, it behooves those who have had EBRT for prostate cancer therapy to take all possible steps to avoid a fracture. This would not likely be a concern of your radiotherapist, but would be more the domain of an endocrinologist or your family practitioner or internist. So print this article, take it to your care provider, and discuss it with him or her. There are multiple Updates on this website regarding the topic of preventing hip fracture. Here are my suggestions:

  • Have a baseline dual-energy X-ray absorptiometry (DXA) to verify your hip BMD status. If it is normal, have follow up DXAs every few years as recommended by your care provider. If your BMD is low, consider osteoporosis therapy with an FDA-approved medication.

  • As approved by your care provider, start a gradually intensifying exercise routine. Ideally this would include hopping, jumping or exercises using a weighted vest, done as many times per week as possible. See this Update, and others on this site, for more details.

  • Have your serum vitamin D tested, and if it is low, take steps to increase it. This could be either through exposure to midday sunlight for several minutes a few times per week (depending up you location and the time of year) and/or from taking vitamin D supplements. See this Update for more on the vitamin D issue.

  • Take steps to decrease the risk of a fall. This could include special exercises to improve balance, removing hazards in your house: rugs, small tables or stands, etc., and just being extra cautious, especially in poor lighting conditions. Note that last week's Update found the bathroom the riskiest room in the house for fracture.

J Clin Endocrinol Metab. 2011 Mar 16. [Epub ahead of print]. Treatment with Denosumab Reduces the Incidence of New Vertebral and Hip Fractures in Postmenopausal Women at High Risk. Boonen S and others. PMID: 21411557. This was a phase-3 clinical trial using 60 mg denosumab (Prolia) or placebo every six months for three years in 7,808 women with osteoporosis. The results showed statistically significant reductions in both vertebral and hip fractures. The authors conclude, “Denosumab reduced the incidence of new vertebral and hip fractures in postmenopausal women with osteoporosis at higher risk for fracture. These results highlight the consistent antifracture efficacy of denosumab in patients with varying degrees of fracture risk.”

Editor's comments. This study is in line with the antifracture results of previous studies using denosumab every six months. To my knowledge this is only approved for women at this time, but would be available as an off-label medication for men wishing to use it. See this Update for additional information about denosumab.

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