Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Arch Osteoporos. 2018 Apr 4;13(1):38. doi: 10.1007/s11657-018-0453-5.
We aimed to study the utility of the FRAX tool in predicting fractures in patient's receiving a hematopoietic stem cell transplantation (HSCT). Our results indicate that the FRAX tool has modest fracture predictive ability in patients greater than 50 years of age at the time of HSCT.
Identifying patients at high risk of osteoporotic fractures following HSCT is challenging. We aimed to evaluate the utility of the FRAX tool at the time of HSCT in predicting fractures following transplant.
We conducted a retrospective chart review of adults (> 18 years) who underwent HSCT at MD Anderson Cancer Center from January 1, 2001, to December 31, 2010, and were followed until December 31, 2013, to identify osteoporotic fractures. Multivariate Cox regression models were built using FRAX score thresholds of low risk < 10%, medium risk 10 to 20%, and high risk > 20% probability of osteoporotic fracture.
We identified 5170 patients who had undergone HSCT, 10% of whom developed an osteoporotic fracture during a median follow-up of 3.2 years. In patients > 65 years of age, those with medium risk (hazard ratio (HR) 2.38, 95% confidence interval (CI) 1.27-4.47) and high risk (HR 3.41, 95% CI 1.73-6.75) had a greater probability of developing an osteoporotic fracture compared to those at low risk. Similar trends were seen in patients 50 to 65 years of age.
In patients greater than 50 years, the FRAX tool has modest predictive ability and could be used to aid in preventive treatment decision-making at the time of transplant.
确定接受造血干细胞移植（HSCT）患者发生骨质疏松性骨折的高风险患者具有挑战性。我们旨在评估在 HSCT 时使用 FRAX 工具预测移植后骨折的效用。
我们对 2001 年 1 月 1 日至 2010 年 12 月 31 日期间在 MD 安德森癌症中心接受 HSCT 的成年人（>18 岁）进行了回顾性图表审查，并随访至 2013 年 12 月 31 日，以确定骨质疏松性骨折。使用 FRAX 评分低风险<10%、中风险 10%至 20%和高风险>20%的骨折概率阈值构建多变量 Cox 回归模型。
我们确定了 5170 名接受 HSCT 的患者，其中 10%在中位随访 3.2 年后发生骨质疏松性骨折。在>65 岁的患者中，中危（风险比（HR）2.38，95%置信区间（CI）1.27-4.47）和高危（HR 3.41，95%CI 1.73-6.75）患者发生骨质疏松性骨折的可能性高于低危患者。在 50 至 65 岁的患者中也观察到了类似的趋势。
在>50 岁的患者中，FRAX 工具具有适度的预测能力，可用于辅助移植时的预防性治疗决策。
