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Results from the treatment period showed that radium-223 was generally well tolerated. Follow-up was subsequently extended to 3\u00a0years to collect data on fracture events. Results of the extended follow-up are now reported.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This prospective, non-interventional, multicenter, single-cohort PMS study enrolled men with CRPC and bone metastases treated with radium-223 under clinical practice. Extended follow-up lasted until 3\u00a0years after the first administration of radium-223. Data on clinical fractures and survival were collected.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>A total of 334 patients were enrolled, with a median follow-up of 15.3\u00a0months (range 1\u201350). The overall incidence proportion of fractures reported as adverse events was 7.76% (95% confidence interval [CI] 5.09\u201311.25%), with a fracture incidence rate of 5.22 patients [with fracture]\/100 person-years (PY). Patients who received bone-modifying agents (BMAs) had a numerically lower incidence of fractures (5.85%; 3.46\/100PY vs 9.93%; 7.92\/100PY). Median overall survival was 26.32\u00a0months (95% CI 21.65-not reached).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Compared with existing reference data, there was no obvious increase in the incidence of clinical fractures in Japanese patients with mCRPC who were treated with radium-223 under clinical practice. As is already well known for androgen deprivation, BMAs may also be useful in reducing bone fracture after radium-223.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s10147-025-02846-7","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T03:33:18Z","timestamp":1754623998000},"page":"2118-2127","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Post-marketing surveillance of radium-223 chloride in Japanese patients with castration-resistant prostate cancer with bone metastasis\u2014final analysis of 3-year extended follow-up focusing on bone fractures"],"prefix":"10.1007","volume":"30","author":[{"given":"Naoya","family":"Masumori","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Hosono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunji","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiyuki","family":"Kakehi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirotsugu","family":"Uemura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiyuki","family":"Sunaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kako","family":"Shimotsumagari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Matsuba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masatoshi","family":"Adachi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruka","family":"Kakiuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seigo","family":"Kinuya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,8]]},"reference":[{"issue":"5","key":"2846_CR1","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1053\/hp.2000.6698","volume":"31","author":"L Bubendorf","year":"2000","unstructured":"Bubendorf L, Sch\u00f6pfer A, Wagner U et al (2000) Metastatic patterns of prostate cancer: an autopsy study of 1,589 patients. 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