Associated Medical Professionals of New York, Syracuse, NY.
SUNY Upstate Medical University, Syracuse, NY.
Urology. 2014 Jul;84(1):164-8. doi: 10.1016/j.urology.2013.12.071.
To estimate the risk of fracture (Fracture Risk Assessment Tool [FRAX] algorithm) because of the development of osteoporosis in prostate cancer patients undergoing androgen deprivation therapy (ADT) for patients who would otherwise not have been identified for treatment by the T score.
This study includes men undergoing ADT for prostate cancer at our urology group. Clinical data were collected via chart review. Subjects were evaluated for fracture risk using country specific (for the United States of America) World Health Organization's FRAX. The FRAX calculations were then compared to fracture risk as determined by T score, for a subset of our cohort that received dual-energy X-ray absorptiometry.
Our cohort consisted of 613 patients on ADT, 94 of which had a dual-energy X-ray absorptiometry scan. The FRAX algorithm identified 61.6% patients requiring therapy without bone mass density (BMD), 46.8% with BMD, and 19.14% with T score alone. In addition, positive correlation was found between FRAX with and without BMD as well as T score and FRAX with BMD and without BMD.
Our data indicate that many patients who were not found at significant risk for fracture with T score were in fact found to be at risk with the FRAX calculation. The largest proportion of patients was found to be at risk through the FRAX calculation without BMD, followed by FRAX with BMD, followed by T score alone. The utility of FRAX is beneficial in identifying patients that may benefit from effective bone-tropic treatment modalities.
评估因接受雄激素剥夺治疗（ADT）而发生骨质疏松症的骨折风险（骨折风险评估工具 [FRAX] 算法），这些患者如果不根据 T 评分，原本不会被确定接受治疗。
本研究纳入了在我们泌尿科接受 ADT 治疗前列腺癌的男性。通过病历回顾收集临床数据。使用特定国家（美国）的世界卫生组织 FRAX 评估患者的骨折风险。然后将 FRAX 计算结果与接受双能 X 线吸收法检查的亚组的 T 评分确定的骨折风险进行比较。
我们的队列包括 613 名接受 ADT 的患者，其中 94 名患者接受了双能 X 线吸收法检查。FRAX 算法确定了 61.6%的无需骨密度（BMD）检查就需要治疗的患者、46.8%的有 BMD 检查结果的患者和 19.14%的仅根据 T 评分的患者需要治疗。此外，还发现 FRAX 无论是否有 BMD 以及 T 评分与 FRAX 有 BMD 和无 BMD 之间存在正相关关系。
我们的数据表明，许多 T 评分未发现骨折风险显著增加的患者实际上通过 FRAX 计算被发现存在风险。通过无 BMD 的 FRAX 计算发现的患者比例最大，其次是有 BMD 的 FRAX，其次是单独的 T 评分。FRAX 的应用有助于识别可能受益于有效骨靶向治疗的患者。
