Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA.
Arch Osteoporos. 2020 Feb 29;15(1):32. doi: 10.1007/s11657-020-0711-1.
We performed a prospective study using both FRAX and computed tomography to screen for osteoporosis in men undergoing radiation for prostate cancer. We found that implementing routine computed tomography (CT)-based screening was feasible in the setting of a prospective study, but the yield of osteoporosis identification was low in this population.
Men with prostate cancer (PCa) are at increased risk of hip fracture for multiple reasons. Estimation of hip fracture risk with the FRAX tool is currently recommended, but FRAX alone may not identify a portion of men with osteoporosis. We hypothesized that adding bone mineral density (BMD) screening using CT to FRAX is feasible and would identify more men with osteoporosis.
Men with PCa scheduled to undergo CT simulation for radiation treatment were enrolled in a single-arm prospective study. The mean attenuation of the mid-L5 vertebral body trabecular bone (L5) was calculated on a single slice using the radiation simulation CT scan. The 10-year risk of hip fracture was calculated using the FRAX tool. Dual energy X-ray absorptiometry (DXA) was performed for men whose L5 measurement was less than 130 Hounsfield units (HU).
A total of 98 eligible men were enrolled and underwent FRAX and CT screening. The median 10-year risk of hip fracture was 1.1% and exceeded 3% in 16 cases; the median L5 was 162.28 HU (range 55.6-526.1 HU). DXA scan was completed in 15 men who had L5 < 130 HU but 10-year calculated hip fracture risk < 3%, 1 of whom was found to have osteoporosis (T-score ≤ -2.5).
Implementing CT-based BMD screening was feasible in the setting of a prospective study for men receiving radiation for PCa, but fewer cases than anticipated of osteoporosis were identified.
由于多种原因，患有前列腺癌（PCa）的男性发生髋部骨折的风险增加。目前建议使用 FRAX 工具来估计髋部骨折风险，但 FRAX 单独可能无法识别出一部分患有骨质疏松症的男性。我们假设，通过将 CT 骨密度（BMD）筛查添加到 FRAX 中，可以确定更多患有骨质疏松症的男性。
计划接受 CT 模拟放射治疗的 PCa 男性患者被纳入单臂前瞻性研究。使用放射模拟 CT 扫描在单个切片上计算中 L5 椎体小梁骨（L5）的平均衰减。使用 FRAX 工具计算 10 年髋部骨折风险。对于 L5 测量值小于 130 亨氏单位（HU）的男性进行双能 X 线吸收法（DXA）检查。
共纳入 98 名符合条件的男性患者，并进行了 FRAX 和 CT 筛查。中位 10 年髋部骨折风险为 1.1%，16 例超过 3%；中位 L5 为 162.28 HU（范围 55.6-526.1 HU）。15 名 L5<130 HU 但 10 年计算髋部骨折风险<3%的男性完成了 DXA 扫描，其中 1 名被诊断为骨质疏松症（T 评分≤-2.5）。
在接受 PCa 放射治疗的男性中，实施基于 CT 的 BMD 筛查是可行的，但预计会有较少的骨质疏松症病例被识别出来。
