Division of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
J Urol. 2010 Jun;183(6):2200-5. doi: 10.1016/j.juro.2010.02.022.
Osteoporosis causes morbidity and mortality in men. The National Osteoporosis Foundation recommends fracture risk assessment with the online WHO/FRAX tool. Although androgen deprivation therapy for prostate cancer increases fracture risk, there is limited information about which men require preventative drug therapy. We applied the WHO/FRAX tool to men treated with androgen deprivation therapy for prostate cancer.
Information was collected from a practice cohort of men treated with gonadotropin-releasing hormone agonists, and included age, height, weight, history of gonadotropin-releasing hormone agonist treatment, dual energy x-ray absorptiometry results, prior bone targeted therapy and clinical risk factors for fracture. Subjects were evaluated with the WHO/FRAX algorithm (http://www.shef.ac.uk/FRAX/).
A total of 363 men treated with androgen deprivation therapy (median age 72 years) were evaluated. By the FRAX algorithm with clinical information (no dual energy x-ray absorptiometry data) the 3% hip fracture risk threshold for treatment was exceeded by 51.2% of the men (median risk 3.1%). When subjects were grouped by age the treatment threshold was reached by 3.3% of those younger than 70 years, 76.6% of those 70 to 79 years old and by 98.8% of those 80 years old or older. Using FRAX with bone mineral density data in the 93 patients who underwent bone mineral density testing the median 10-year hip fracture risk was 0.9% and the treatment threshold was exceeded by 15% of these subjects.
In this cohort of men receiving androgen deprivation therapy the prevalence of risk sufficient to necessitate drug therapy was high and was strongly influenced by age. The WHO/FRAX algorithm identifies a greater proportion of men for treatment than the traditional threshold of T score -2.5 or less.
骨质疏松症可导致男性发病和死亡。国家骨质疏松基金会建议使用在线 WHO/FRAX 工具进行骨折风险评估。虽然前列腺癌的雄激素剥夺疗法会增加骨折风险，但关于哪些男性需要预防性药物治疗的信息有限。我们将 WHO/FRAX 工具应用于接受雄激素剥夺疗法治疗前列腺癌的男性。
从接受促性腺激素释放激素激动剂治疗的男性实践队列中收集信息，包括年龄、身高、体重、促性腺激素释放激素激动剂治疗史、双能 X 线吸收法结果、既往骨靶向治疗和骨折临床危险因素。受试者采用 WHO/FRAX 算法（http://www.shef.ac.uk/FRAX/）进行评估。
共评估了 363 名接受雄激素剥夺疗法治疗的男性（中位年龄 72 岁）。根据包含临床信息的 FRAX 算法（无双能 X 线吸收法数据），51.2%的男性（中位风险 3.1%）超过了 3%髋部骨折风险的治疗阈值。当根据年龄对受试者进行分组时，3.3%的 70 岁以下男性、76.6%的 70-79 岁男性和 98.8%的 80 岁及以上男性达到了治疗阈值。在对接受骨密度检测的 93 名患者使用 FRAX 和骨密度数据的情况下，中位 10 年髋部骨折风险为 0.9%，其中 15%的患者超过了治疗阈值。
在接受雄激素剥夺疗法治疗的男性队列中，需要药物治疗的风险程度高，且强烈受年龄影响。与传统的 T 评分-2.5 或更低的阈值相比，WHO/FRAX 算法识别出更多需要治疗的男性。
