Comparison of Fracture Risk Assessment Tool Score to Bone Mineral Density for Estimating Fracture Risk in Patients With Advanced Prostate Cancer on Androgen Deprivation Therapy

38 Background: Androgen deprivation therapy (ADT) is a cornerstone of advanced prostate cancer (PCa) treatment, however several side-effects are associated with its long-term use. Notably, loss of bone mineral density (BMD) is accelerated which increases fracture risk. Guidelines recommend BMD testing when initiating ADT to properly assess baseline fracture risk. The objective was to examine the proportion of BMD testing in men initiating long-term ADT in Quebec. Methods: The cohort consists of men extracted from Quebec public healthcare insurance administrative databases who were diagnosed with PCa from 2001-2012 and treated by ADT for at least one continuous year. The primary study outcome was the receipt of baseline BMD testing (defined as a BMD test identified in the period from 6 months prior to and up to 12 months after ADT initiation). Multivariable generalized linear mixed with a logit link was performed to identify variables associated with baseline BMD testing accounting for physician clustering. Results: We identified 7,069 patients, of which 887 (12.6%) underwent baseline BMD testing. Baseline BMD testing varied by year of ADT initiation, from 7.7% in 2001-2003 to 12.3% in 2013-2012. Following multivariable analyses, later years of ADT initiation (2004-2006, 2007-2009, 2010-2012, 2013-2015) remained associated with higher odds of baseline BMD testing compared to the earlier years (2001-2003) (ORs ranging from 1.43-1.88; p < 0.001). Conversely, age > 80 (OR 0.73; 95% CI 0.57-0.94; p = 0.001), greater Charlson comorbidity score (OR 0.51; 95%CI 0.34-0.75; p = 0.001), and rural residence (OR 0.60; 95%CI 0.48-0.75; p < 0.001) were associated with lower odds of baseline BMD testing. Conclusions: In our study population, rates of baseline BMD testing in men initiating ADT are low, although the rates increased over the course of the study period. Potential gaps identified in baseline BMD testing include older, more comorbid patients, and rural residence. Additional efforts emphasizing the importance of BMD testing in PCa guidelines may be needed.

Download Full-text

Automated and Precise Bone Mineral Density Prediction and Fracture Risk Assessment using Hip/Lumbar Spine Plain Radiographs via Learning Deep Image Signatures and Correlations

10.21203/rs.3.rs-371880/v1 ◽

2021 ◽

Author(s):

Chen-I Hsieh ◽

Kang Zheng ◽

Chihung Lin ◽

Le Lu ◽

Weijian Li ◽

...

Keyword(s):

Bone Mineral Density ◽

Risk Assessment ◽

Lumbar Spine ◽

Fracture Risk ◽

Bone Mineral ◽

Assessment Tool ◽

Fracture Risk Assessment ◽

Mineral Density ◽

Spine Radiographs ◽

Automated Tool

Abstract Dual-energy X-ray absorptiometry (DXA) and the Fracture Risk Assessment Tool are recommended tools for osteoporotic fracture risk evaluation, but are underutilized. We present a novel and fully-automated tool to identify fractures, predict bone mineral density (BMD), and evaluate fracture risk using plain pelvis and lumbar spine radiographs. The performance of this tool were evaluated in 1639 and 11908 patients with pelvis or lumbar spine radiographs and DXA, respectively. The model was well calibrated for hip and spine BMD assessments with minimal or no bias. The area under the curve and accuracy were 0.89 and 92.4% for hip osteoporosis, 0.87 and 86.8% for spine osteoporosis, 0.92 and 94.6% for high 10-year major fracture risk, and 0.92 and 92.2% for high hip fracture risk, respectively. The success rates of our automated algorithm a real-world test were 85.3% and 90.4% for hip and spine, respectively. The clinical use of this automated tool may increase the likelihood of identifying high-risk patients in previously unscreened populations.

Download Full-text

Corrigendum to “Predictors of Fracture Risk and Bone Mineral Density in Men with Prostate Cancer on Androgen Deprivation Therapy”

Journal of Osteoporosis ◽

10.1155/2017/4982312 ◽

2017 ◽

Vol 2017 ◽

pp. 1-1

Author(s):

Katherine Neubecker ◽

Beverley Adams-Huet ◽

Irfan M. Farukhi ◽

Rosinda Castanon ◽

Ugis Gruntmanis

Keyword(s):

Prostate Cancer ◽

Bone Mineral Density ◽

Fracture Risk ◽

Androgen Deprivation Therapy ◽

Bone Mineral ◽

Androgen Deprivation ◽

Mineral Density

Download Full-text

Contemporary Population-Based Analysis of Bone Mineral Density Testing in Men Initiating Androgen Deprivation Therapy for Prostate Cancer

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2020.7576 ◽

2020 ◽

Vol 18 (10) ◽

pp. 1374-1381

Author(s):

Jason Hu ◽

Armen G. Aprikian ◽

Marie Vanhuyse ◽

Alice Dragomir

Keyword(s):

Prostate Cancer ◽

Bone Mineral Density ◽

Fracture Risk ◽

Androgen Deprivation Therapy ◽

Bone Mineral ◽

Androgen Deprivation ◽

Primary Study ◽

Mineral Density ◽

Bone Mineral Density Testing ◽

Bmd Testing

Background: Androgen deprivation therapy (ADT) is a cornerstone of treatment for advanced prostate cancer (PCa); however, it accelerates the loss of bone mineral density (BMD), which increases fracture risk. Guidelines recommend BMD testing when initiating ADT to assess baseline fracture risk properly. The objective of this study was to examine the proportion of BMD testing in men initiating ADT in Quebec and to identify factors associated with receipt of this testing. Methods: The study cohort consisted of men extracted from Quebec public healthcare insurance administrative databases who initiated continuous ADT from 2000 to 2015 for >12 months. The primary study outcome was receipt of BMD testing in the period from 6 months before through 12 months after ADT initiation. Multivariable generalized linear mixed regression modeling with a logit link was performed to identify variables associated with BMD testing. Results: We identified 22,033 patients, of whom 3,910 (17.8%) underwent BMD testing. Rates of BMD testing increased from 4.1% in 2000 to 23.4% in 2015. After multivariable analyses, prior history of osteoporosis (odds ratio [OR], 1.84; 95% CI, 1.32–2.57; P<.001), rheumatoid arthritis (OR, 1.64; 95% CI, 1.15–2.34; P=.006), use of bisphosphonates (OR, 1.47; 95% CI, 1.25–1.73; P<.001), and long-term corticosteroid use (OR, 1.63; 95% CI, 1.15–2.31; P=.006) were associated with higher odds of BMD testing. Patient age >80 years (OR, 0.67; 95% CI, 0.59–0.76; P<.001), metastases (OR, 0.79; 95% CI, 0.70–0.89; P<.001), higher Charlson comorbidity score (OR, 0.65; 95% CI, 0.51–0.81; P<.001), and rural residence (OR, 0.77; 95% CI, 0.68–0.87; P<.001) were associated with lower odds of BMD testing. Conclusions: In our study population, BMD testing rates in men initiating ADT were low, although they increased over the years especially in the years after the publication of recommendations for BMD testing in these patients. Potential gaps identified include being older, more comorbid, and rural areas. Overall, additional efforts emphasizing the importance of BMD testing in PCa guidelines may be needed.

Download Full-text