Use of denosumab in castration sensitive prostate cancer

In their article, Mitchell and colleagues state that the use of denosumab in men with castration sensitive metastatic prostate cancer who lack an appropriate indication (such as osteoporosis) constitutes non-recommended, low value care.1Standard treatment for this group of patients, however, is androgen deprivation therapy, which inherently carries an increased risk of osteoporosis and fractures.2 Several guidelines, including one from the American Society of Clinical Oncology,2 recommend bisphosphonates or denosumab in patients at increased risk of fractures. Notably, this does not require a diagnosis of osteoporosis.The authors seem to conflate osteoporosis prevention with treatment of bone metastases. The former is recommended while the latter is not. Given the lack of detail in their reported methods, it is not clear how they took this element into account. How did they define indications for osteoporosis prevention?Given the different treatment doses of denosumab used for these indications (either 60 mg every 6 months for…
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