Prediction of vertebral fractures in cancer patients undergoing hormone deprivation therapies: Reliability of who fracture risk assessment tool (frax) and bone mineral density in real-life clinical practice

Gherardo Mazziotti; Walter Vena; Rebecca Pedersini; Sara Piccini; Emanuela Morenghi; Deborah Cosentini; Paolo Zucali; Rosalba Torrisi; Silvio Sporeni; Edda L Simoncini; Roberto Maroldi; Luca Balzarini; Andrea G Lania; Alfredo Berruti

doi:10.1016/j.jbo.2022.100421

Prediction of vertebral fractures in cancer patients undergoing hormone deprivation therapies: Reliability of who fracture risk assessment tool (frax) and bone mineral density in real-life clinical practice

J Bone Oncol. 2022 Mar 9:33:100421. doi: 10.1016/j.jbo.2022.100421. eCollection 2022 Apr.

Authors

Gherardo Mazziotti^{1

2}, Walter Vena², Rebecca Pedersini³, Sara Piccini^{1

2}, Emanuela Morenghi^{1

4}, Deborah Cosentini³, Paolo Zucali^{1

5}, Rosalba Torrisi⁵, Silvio Sporeni², Edda L Simoncini³, Roberto Maroldi^{6

7}, Luca Balzarini⁸, Andrea G Lania^{1

2}, Alfredo Berruti^{3

7}

Affiliations

¹ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
² Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
³ Medical Oncology Unit, ASST Spedali Civili di Brescia, Brescia, Italy.
⁴ Biostatistics Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
⁵ Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
⁶ Radiology Unit, ASST Spedali Civili di Brescia, Brescia, Italy.
⁷ Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy.
⁸ Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.

Abstract

Background and objective: 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.

Design: 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.

Results: Vertebral fractures were found in 140 subjects (26.6%) and spine deformity index was significantly associated with duration of HDTs (rho 0.38; p < 0.001). Only in females, vertebral fractures were significantly associated with FRAX score for major fractures [OR 1.08; P < 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/m² (OR 17.63; P < 0.001), BMD T-score below -1.0 SD at any skeletal site (OR 7.79; P < 0.001) and gonadotropin-releasing hormone agonists (GnRHa) plus abiraterone treatment (OR 11.51; P = 0.001).

Conclusions: 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.

Keywords: Bone mineral density; Breast cancer; FRAX score; Fractures; Hormone deprivation therapy; Osteoporosis; Prostate cancer; Vertebral fractures.