Bone-Modifying Agents in Metastatic Castration-Resistant Prostate Cancer
By
Zeynep Irem Ozay
Yeonjung Jo
Georges Gebrael
Micah Ostrowski
Vinay Mathew Thomas
Haoran Li
Ryon P. Graf
Soumyajit Roy
Benjamin L. Maughan
Avirup Guha
Irbaz Bin Riaz
Emmanuel S. Antonarakis
Rana R. McKay
Neeraj Agarwal
Umang Swami
June 24, 2026
Clinical Scorecard: Therapeutic Agents for Bone Health in Advanced Castration-Resistant Prostate Cancer with Metastases
At a Glance
Category Detail
Condition Metastatic Castration-Resistant Prostate Cancer (mCRPC) Key Mechanisms Bone-modifying agents (BMAs) reduce or delay skeletal-related events (SREs) in mCRPC with bone metastases. Target Population Patients diagnosed with mCRPC, particularly those with bone metastases. Care Setting Oncology clinics in the United States.
Key Highlights
Over 90% of mCRPC patients have bone metastases, leading to a high risk of SREs. 56.6% of patients in the study received BMAs after mCRPC diagnosis. BMA use decreased over time, with denosumab use declining and zoledronic acid use increasing. Clinical guidelines recommend BMAs for men with mCRPC and bone metastases. 43.4% of patients did not receive BMAs, indicating a gap in clinical practice. Guideline-Based Recommendations
Diagnosis
Diagnosis of mCRPC should be confirmed before BMA administration. Management
Use denosumab or zoledronic acid for men with mCRPC with bone metastases. Monitoring & Follow-up
Monitor for skeletal-related events and assess BMA administration timing. Risks
Consider risks of fractures and SREs in patients not receiving BMAs. Patient & Prescribing Data
14,076 patients with mCRPC included in the study.
Median time from mCRPC diagnosis to BMA initiation was 39 days, with 54.1% receiving BMAs within 30 days.
Clinical Best Practices
Increase awareness of bone health in mCRPC patients. Facilitate timely initiation of BMAs to reduce SREs. Address barriers to BMA use, including treatment priorities and concerns about side effects. Related Resources & Content
