Vertebral fractures and trabecular microstructure in men with prostate cancer on androgen deprivation therapy |
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| Authors: | Susan L Greenspan Julie Wagner Joel B Nelson Subashan Perera Cynthia Britton Neil M Resnick |
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| Affiliation: | 1. Division of Endocrinology, University of Pittsburgh, Pittsburgh, PA,;2. Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA,;3. Division of Geriatrics, University of Pittsburgh, Pittsburgh, PA,;4. Division of Radiology, University of Pittsburgh, Pittsburgh, PA, |
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| Abstract: | Androgen deprivation therapy (ADT), a treatment for prostate cancer, is associated with bone loss and fractures. Dual‐energy X‐ray absorptiometry (DXA)–measured bone mineral density does not assess vertebral fractures (VF). High‐resolution micro‐magnetic resonance imaging (HR‐MRI) assesses bone microarchitecture and provides structural information. To determine if VF identification increased the diagnosis of osteoporosis beyond DXA and if HR‐MRI demonstrated skeletal deterioration in men with VF, we cross‐sectionally studied 137 men aged ≥ 60 years with nonmetastatic prostate cancer on ADT for ≥ 6 months. Vertebral fracture assessment (VFA) by DXA was confirmed with X‐rays. HR‐MRI of the wrist included bone volume to total volume (BV/TV), surface density (trabecular plates), surface/curve ratio (plates/rods), and erosion index (higher depicts deterioration). VF were found in 37% of men; the majority were unknown. Seven percent of participants were classified as osteoporotic by hip or spine DXA. Thirty‐seven percent of men without osteoporosis by DXA had VF identified, suggesting that 90% of patients with clinical osteoporosis would have been misclassified by DXA alone. By ANOVA comparison across VF grades, the BV/TV, surface density, and spine, hip, and wrist DXA were lower, and erosion index was higher in men with moderate‐severe VF compared with lesser grades (all p < 0.05). By unadjusted ROC analysis, the addition of HR‐MRI to DXA at the spine, hip, and femoral neck added substantially (AUC increased 0.831 to 0.902, p < 0.05) to prediction of moderate‐severe vertebral fracture. HR‐MRI indices were associated with spine, hip, and wrist DXA measures (p < 0.01). Longer duration of ADT was associated with lower BV/TV, surface density, and surface/curve ratio (p < 0.05). ADT for men with prostate cancer is associated with silent VF. DXA alone leads to misclassifications of osteoporosis, which can be avoided by VF assessment. HR‐MRI provides a novel technique to assess deterioration of structural integrity in men with VF and adds micro‐structural information. © 2013 American Society for Bone and Mineral Research |
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| Keywords: | PROSTATE CANCER OSTEOPOROSIS BONE DENSITOMETRY RADIOLOGY |
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