There is a need to determine if there is a preferred non-oral agent to increase bone mineral density (BMD) in men with osteoporosis, particularly for cases when patients have failed on or cannot tolerate oral bisphosphonates, for patients with comorbidities that may affect choice of therapy, or for men with early prostate cancer undergoing androgen-deprivation therapy (ADT). In 2015, denosumab (Prolia) was evaluated by the CADTH Common Drug Review (CDR) for the treatment of osteoporosis in men, but zoledronic acid has not been reviewed by CDR for this indication. The Canadian Drug Expert Committee (CDEC) noted that at the time of the CDR review, there were no direct comparisons of denosumab with other therapeutic agents approved for the treatment of men with osteoporosis. The purpose of this report is to evaluate the comparative clinical effectiveness of denosumab and zoledronic acid for the treatment of men with osteoporosis, including men with non-metastatic prostate cancer who are receiving ADT, and to identify evidence-based guidelines for the use of these agents for these indications.
Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that the Canadian Agency for Drugs and Technologies in Health (CADTH) could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.