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. 2022 Mar 9:33:100421.
doi: 10.1016/j.jbo.2022.100421. eCollection 2022 Apr.

Prediction of vertebral fractures in cancer patients undergoing hormone deprivation therapies: Reliability of who fracture risk assessment tool (frax) and bone mineral density in real-life clinical practice

Gherardo Mazziotti  1   2 , Walter Vena  2 , Rebecca Pedersini  3 , Sara Piccini  1   2 , Emanuela Morenghi  1   4 , Deborah Cosentini  3 , Paolo Zucali  1   5 , Rosalba Torrisi  5 , Silvio Sporeni  2 , Edda L Simoncini  3 , Roberto Maroldi  6   7 , Luca Balzarini  8 , Andrea G Lania  1   2 , Alfredo Berruti  3   7
Affiliations

Prediction of vertebral fractures in cancer patients undergoing hormone deprivation therapies: Reliability of who fracture risk assessment tool (frax) and bone mineral density in real-life clinical practice

Gherardo Mazziotti et al. J Bone Oncol. .

Abstract

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 gonadotropin-releasing hormone agonists (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.

Keywords: Bone mineral density; Breast cancer; FRAX score; Fractures; Hormone deprivation therapy; Osteoporosis; Prostate cancer; Vertebral fractures.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Mazziotti received consultancy fees from Novartis, Ipsen, Eli Lilly and lecture fees from Amgen and Abiogen, outside the submitted work. Dr. Vena received grants from IBSA Pharmaceutical outside the submitted work. Dr. Zucali reports receiving, outside the submitted work, personal fees for an advisory role, speaker engagements and travel and accommodation expenses from Merck Sharp & Dohme (MSD), Astellas, Janssen, Sanofi, Ipsen, Pfizer, Novartis, Bristol Meyer Squibb, Amgen, Astrazeneca, Roche, and Bayer. Dr. Torrisi received research grants from Pfizer, consultancy fees from MSD and lecture fees from Pfizer, Eli Lilly, EISAI and Genomic Health outside the submitted work. Dr. Lania received grants from Pfizer and consultancy fees from Ipsen, outside the submitted work. Dr Berruti reports receiving grants and personal fees from Janssen Cilag, grants and personal fees from Astellas, and personal fees from Bayer outside the submitted work.

Figures

Fig. 1
Fig. 1
Prevalence of vertebral fractures (VFs) in 527 subjects (429 females with breast cancer and 98 males with prostate cancer) stratified for quartiles of hormone-deprivation therapies (HDTs) duration.
Fig. 2
Fig. 2
Prevalence of total vertebral fractures (VFs), densitometric diagnosis of osteoporosis and FRAX score for major fractures ≥ 20 in 429 females with breast cancer under estrogen-deprivation therapies and 98 males with prostate cancer under androgen-deprivation therapies. *, P < 0.001 vs. males; **, P < 0.001 vs. females. The P values were derived from chi squared test.
Fig. 3
Fig. 3
Prevalence of total vertebral fractures (VFs) and multiple/moderate/severe VFs [i.e., those with spine deformity index (SDI) ≥ 2] in 98 males with prostate cancer under androgen-deprivation therapies and stratified for body mass index (BMI). *, P < 0.001 vs. BMI < 25 Kg/m2. The P values were derived from chi squared test.
Fig. 4
Fig. 4
Risk of vertebral fractures (VFs) in subgroups of male (M) subjects with prostate cancer under androgen-deprivation therapies, stratified for body mass index (BMI), bone mineral density (BMD) and abiraterone therapy. The odds ratio (OR) and 95% confidence intervals were reported in each root when the number of subjects and the events permitted the statistical analyses.
Supplementary figure 1
Supplementary figure 1
ROC curve calculating the performance of FRAX score for major fractures in identifying females with breast cancer with vertebral fractures under estrogen deprivation therapies.
See this image and copyright information in PMC

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