Relative Effectiveness of Osteoporosis Treatments to Reduce Hip Fractures in Patients with Prostate Cancer on Continuous Androgen Deprivation Therapy:

Background: Androgen deprivation therapy (ADT) is widely used in men with advanced prostate cancer, and can lead to loss of bone mineral density (BMD) and fractures. Osteoporosis treatments are effective in improving BMD, and reducing risk of hip fractures. Given the potential benefits, risks, and widely varying costs of osteoporosis treatments in our population, we assessed the effects and cost-effectiveness of treatments. Methods: A systematic review and a network meta-analysis were conducted using randomized controlled trials (RCT) that evaluated bisphosphonates, denosumab, toremifene, and raloxifene in patients with non-metastatic prostate cancer on ADT. Outcomes included percentage change in BMD from placebo at different bone sites and incidence rates of any fractures. A cost-utility model was developed using a state transition model simulating the progression of prostate cancer, the incidence of hip fractures and an adverse event from osteoporosis treatments. The risk of fracture was conditional on BMD changes, which were modeled as the means of determining the effect of treatment on health and cost outcomes. The outcomes were predicted hip fracture incidence, quality-adjusted life years (QALYs), expected costs, and incremental cost-effectiveness ratios. Results: Thirteen RCTs were included for analysis. The largest BMD improvement compared to placebo at 12-month at femoral neck site was risedronate 6.77% (95% CrI:-6.87-20.27%). Two studies reported fractures; toremifene and denosumab studies reported improved incidence of new vertebral fracture outcome vs placebo (2.5% vs 4.9%;pPh.D.2019-11-19 00:00:0