Oncology Patients at High Risk of Bone Fracture: Advances in Pharmacotherapy (ACPE)

The use of androgen deprivation therapy for prostate cancer has greatly increased in the last 15 years because statistics have shown it has about a 25% better 10 year mortality outcome when compared to observation alone. It has been associated with reductions in morbidity and metastases and increased survival rates when combined with radiation both in more advanced stages of the disease and in disease confined to the prostate. Adjuvant aromatase inhibitor (AI) therapy is a common treatment in postmenopausal women with hormone receptor positive breast cancer. Bone fractures are of particular concern in these patents, given their association with increased mortality in prostate cancer and breast cancer patients. Studies have shown that about 19.4% of men who received androgen deprivation therapy experienced a fracture, and 5.2% of them required hospitalization.

Patients taking AIs or androgen deprivation therapy have benefited from vitamin D, calcium, and bisphosphonate therapy. Denosumab, used in patients receiving AIs has been shown to significantly increase lumbar spine BMD by 7.6% from baseline versus placebo.Increases were observed as early as 1 month from beginning of therapy and were not influenced by duration of AI therapy.Increases in BMD can also be seen in the hip, total body, and femoral neck.

Objectives:

1. Apply screening criteria to a patient receiving AI therapy or androgen deprivation therapy
Describe the criteria for initiation of pharmacotherapy in a patient receiving aromatase inhibitor (AI) therapy or androgen deprivation therapy and apply them to a patient case
2. Identify present pharmacotherapeutic treatments for management of a patient receiving AI therapy or androgen deprivation therapy, and describe their mechanisms of action and place in therapy
3. Describe the challenges associated with treating patients receiving AI or androgen deprivation therapies, focus specifically on the risks (e.g., adverse drug reactions, drug interactions, et cetera) of the agents and apply the information in optimizing patient care in a patient case

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Credit Designation:

ScientiaCME is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmaceutical education. This program is approved for 0.75 hours of continuing education. Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test. Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit.