ECE2022 Poster Presentations Calcium and Bone (68 abstracts)
Background: Skeletal fragility is an important clinical issue in women with early-stage breast cancer and men with non-metastatic prostate cancer under hormonal hormone deprivation therapies (HDTs). Vertebral fractures (VFs) have been reported in a remarkable number of subjects exposed to HDT especially when the diagnosis of fractures is performed by a radiological and morphometric approach. Notably, prediction of fractures in this clinical setting is a challenge and determinants of fractures are still largely unknown. Current international guidelines rely on bone mineral density (BMD) and the WHO Fracture Risk Assessment Tool (FRAX) to identify cancer survivors at high risk of fractures to be treated in primary prevention, but their reliability in this setting of secondary osteoporosis seems to be inaccurate. In this study, reflecting the real-life clinical practice, we investigated the diagnostic performance of FRAX algorithm and BMD in identifying breast and prostate cancer survivors developing VFs during HDTs.
Methods: This cross-sectional study included 527 consecutive subjects (429 females with breast cancer, 98 males with prostate cancer; median age 61 years) at two referral centers in Italy. At study entry, all participants had been under HDTs for at least 6 months and none received bone-active drugs. Prevalence of VFs was assessed by a morphometric approach, in relationship with FRAX score, body mass index (BMI), BMD, age, duration and type of HDTs.
Results: VFs were found in 140 subjects (26.6%) with spine deformity index was significantly associated with duration of HDTs (rho 0.38; P<0.001). The prevalence of VFs was significantly higher in males with prostate cancer than females with breast cancer (45.9% vs. 22.1%; P<0.001). In females with breast cancer, VFs were significantly associated with FRAX score for major fractures [OR 1.07; P<0.001] after correction for age (P=0.853) and BMD (P=0.097). The best cut-off of FRAX score for major fractures for identifying subjects with VFs was 6.35%, with sensitivity and specificity of 62.0% and 61.9%, respectively. In males with prostate cancer, VFs were significantly and independently associated with BMI≥25 Kg/m2 (OR 11.86; P<0.001), BMD T-score below -1.0 SD (OR 7.89; P=0.001) and GnRHa plus abiraterone treatment (OR 20.28; P=0.002), after correction for age (P=0.111) and FRAX score for major fractures (P=0.199).
Conclusions: FRAX and BMD could be useful for predicting VFs in subjects undergoing HDTs, but the thresholds are lower than those applied in primary osteoporosis. Notably, high BMI is a determinant of VFs in males under HDT.
21 May 2022 - 24 May 2022