Many patients with advanced genitourinary
malignancies develop bone
metastases, which can lead to potentially debilitating skeletal complications. Moreover,
age-related bone loss and
cancer treatments such as hormonal
therapy for
prostate cancer can weaken bone, placing patients at risk for
osteoporotic fractures in addition to skeletal-related events (SREs) from bone
metastases.
Zoledronic acid, a
bisphosphonate, is approved worldwide to reduce the risk of SREs in patients with bone
metastases from solid
tumors or bone lesions from
multiple myeloma.
Zoledronic acid, although underutilized in genitourinary
malignancies, has long been the mainstay of treatment in patients with bone
metastases, and can also help preserve bone during anticancer
therapy. Recently,
denosumab, a
monoclonal antibody directed against the
receptor activator of nuclear factor kappa-B ligand, was approved in the United States and the European Union for reducing the risk of SREs in patients with bone
metastases from solid
tumors.
Denosumab (at a lower dose) is also approved in the European Union and the United States to treat
androgen deprivation-induced bone loss in men with
prostate cancer. In addition, preclinical rationale and emerging clinical data suggest that bone-modifying agents may be able to delay
disease progression in
genitourinary cancers, just as newly developed anticancer treatments have produced reductions in SREs, possibly by indirect effects on the disease course. This review article summarizes current data and ongoing studies to preserve bone health in patients with advanced
genitourinary cancers.