Background and Objective

Prediction of fractures in cancer survivors exposed to hormone-deprivation therapies (HDTs) is a challenge since bone loss is rapid and severe, and determinants of fractures in this setting are still largely unknown. In this study we investigated reliability of the WHO Fracture Risk Assessment Tool (FRAX) and bone mineral density (BMD) to identify subjects developing vertebral fractures during HDTs

Design

Five-hundred-twenty-seven consecutive subjects (429 females with breast cancer, 98 males with prostate cancer; median age 61 years), under HDTs for at least 6 months, were evaluated for vertebral fractures by a radiological and morphometric approach, in relationship with FRAX score, body mass index (BMI), BMD, age and duration of HDTs.

Results

Vertebral fractures were found in 140 subjects (26.6%) and spine deformity index was significantly associated with duration of HDTs (rho 0.38; p<0.001). Only in females, vertebral fractures were significantly associated with FRAX score for major fractures [OR 1.08; P<0.001]. The best cut-off of FRAX score for major fractures, as calculated by receiving operating characteristic (ROC) analysis was 6.35%. In males, however, vertebral fractures were significantly and independently associated with BMI≥25 Kg/m² (OR 17.63; P<0.001), BMD T-score below -1.0 SD at any skeletal site (OR 7.79; P<0.001) and GnRHa plus abiraterone treatment (OR 11.51; P=0.001).

Conclusions

FRAX and BMD may be useful for predicting vertebral fractures in subjects undergoing HDTs, but the thresholds seem to be lower than those used in the general population. High BMI is a determinant of vertebral fractures in males under HDT.

中文翻译：

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接受激素剥夺治疗的癌症患者椎体骨折的预测：现实临床实践中 WHO 骨折风险评估工具 (frax) 和骨矿物质密度的可靠性

背景与目的

预测接受激素剥夺疗法 (HDT) 的癌症幸存者的骨折是一项挑战，因为骨质流失迅速且严重，而在这种情况下骨折的决定因素仍然很大程度上未知。在这项研究中，我们调查了 WHO 骨折风险评估工具 (FRAX) 和骨矿物质密度 (BMD) 的可靠性，以确定在 HDT 期间发生椎骨骨折的受试者

设计

连续 527 名受试者（429 名患有乳腺癌的女性，98 名患有前列腺癌的男性；中位年龄 61 岁），在 HDTs 下至少 6 个月，通过放射学和形态测量方法评估椎骨骨折，关系FRAX 评分、体重指数 (BMI)、BMD、年龄和 HDT 持续时间。

结果

在 140 名受试者 (26.6%) 中发现了脊椎骨折，脊柱畸形指数与 HDT 的持续时间显着相关 (rho 0.38；p< 0.001)。仅在女性中，椎体骨折与严重骨折的 FRAX 评分显着相关 [OR 1.08; P <0.001]。通过接受操作特征 (ROC) 分析计算得出的主要骨折 FRAX 评分的最佳截止值为 6.35%。然而，在男性中，椎骨骨折与 BMI≥25 Kg/m ² (OR 17.63; P <0.001)、任何骨骼部位的 BMD T 评分低于 -1.0 SD (OR 7.79; P <0.001) 和GnRHa 加阿比特龙治疗（OR 11.51；P = 0.001）。

结论

FRAX 和 BMD 可能有助于预测接受 HDT 的受试者的椎体骨折，但阈值似乎低于一般人群中使用的阈值。高 BMI 是 HDT 下男性椎体骨折的决定因素。