Mazziotti Gherardo, Vena Walter, Pedersini Rebecca, Piccini Sara, Morenghi Emanuela, Cosentini Deborah, Zucali Paolo, Torrisi Rosalba, Sporeni Silvio, Simoncini Edda L, Maroldi Roberto, Balzarini Luca, Lania Andrea G, Berruti Alfredo
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
J Bone Oncol. 2022 Mar 9;33:100421. doi: 10.1016/j.jbo.2022.100421. eCollection 2022 Apr.
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.
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.
Vertebral fractures were found in 140 subjects (26.6%) and spine deformity index was significantly associated with duration of HDTs (rho 0.38; 0.001). Only in females, vertebral fractures were significantly associated with FRAX score for major fractures [OR 1.08; < 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/m (OR 17.63; < 0.001), BMD T-score below -1.0 SD at any skeletal site (OR 7.79; < 0.001) and gonadotropin-releasing hormone agonists (GnRHa) plus abiraterone treatment (OR 11.51; = 0.001).
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.
预测接受激素剥夺疗法（HDTs）的癌症幸存者发生骨折是一项挑战，因为骨质流失迅速且严重，且该情况下骨折的决定因素仍大多未知。在本研究中，我们调查了世界卫生组织骨折风险评估工具（FRAX）和骨密度（BMD）用于识别接受HDTs治疗期间发生椎体骨折患者的可靠性。
对连续527名受试者（429名乳腺癌女性患者，98名前列腺癌男性患者；中位年龄61岁）进行评估，这些受试者接受HDTs治疗至少6个月，采用放射学和形态学方法评估椎体骨折情况，并分析其与FRAX评分、体重指数（BMI）、骨密度、年龄及HDTs治疗持续时间的关系。
140名受试者（26.6%）发现椎体骨折，脊柱畸形指数与HDTs治疗持续时间显著相关（rho 0.38；P<0.001）。仅在女性中，椎体骨折与主要骨折的FRAX评分显著相关[比值比（OR）1.08；P<0.001]。通过接受者操作特征（ROC）分析计算得出的主要骨折FRAX评分最佳截断值为6.35%。然而，在男性中，椎体骨折与BMI≥25 Kg/m²显著且独立相关（OR 17.63；P<0.001），与任何骨骼部位的骨密度T值低于 -1.0标准差显著相关（OR 7.79；P<0.001），与促性腺激素释放激素激动剂（GnRHa）加阿比特龙治疗显著相关（OR 11.51；P = 0.001）。
FRAX和骨密度可能有助于预测接受HDTs治疗的患者发生椎体骨折，但阈值似乎低于一般人群中使用的阈值。高BMI是接受HDT治疗男性发生椎体骨折的一个决定因素。
