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AI InsightTherefore, models like Garvan calculator with both 5- and 10-year risk estimateshave to be developed for these patients.
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Özet
Objective: Maintaining the optimum bone health is one of the important concerns in patients withprostate cancer, but it usually remains neglected. Failure to screen these patients is detrimental to boththe length and the quality of life. The estimation of bone mineral density (BMD) and more recentlythe World Health Organization’s fracture risk assessment (FRAX) algorithm in appropriate patients isrecommended by several specialty organizations/associations at the time of instituting androgen deprivation therapy (ADT) for metastatic and high-risk individuals. It provides a 10-year risk evaluation ofhip and major osteoporotic fractures (MOF). Using this web-based new investigating tool, candidatesat high risk of fractures can be predicted more accurately according to clinical risk factors (CRF) aloneor in combination with the femoral neck BMD. The FRAX application for senile osteoporosis has beenstudied and reviewed extensively, but no systematic review has ever been conducted for assessing theimplication of FRAX in prostate cancer. This review article will give insight about the validity, role,and utility of this investigating tool in clinical practice for fracture risk assessment in these individuals.Material and methods: This systematic review was carried out as per the Preferred Reporting Itemsfor Systematic Reviews and Meta-analyses guidelines and Cochrane review principles. We searchedthe PubMed, Cochrane database of systematic reviews, and the EMBASE electronic database untilDecember 2018 using the medical subject heading terms prostate cancer and FRAX.Results: A total of nine studies meet the inclusion criteria and were included in the review. Thesestudies enrolled a total of 3704 patients (sample size range, 78–1220) of localized, metastatic, castration resistant prostate cancer with or without ADT and/or on photon or radiotherapy. The factorsthat influenced FRAX included age, ethnicity, baseline BMD, duration of ADT, presence of CRF, andmeasurement methods (CRF, with/without BMD, computed tomography based). An advanced age andduration of ADT were the most robust risk factors. A 10-year MOF and hip fracture risk estimation washigher when the femoral neck BMD was not incorporated in the FRAX measurement. Despite severalwell-known strengths of using FRAX in the fracture risk assessment of suitable candidates with prostate cancer, several risk factors such as the mode/duration of ADT, mode of radiotherapy, Vitamin Dlevels, bone remodeling markers, and recent/recurrent fractures need to be incorporated in the FRAXcalculator for improving the predictive ability. In contrast to senile osteoporosis with a longer life expectancy, the fracture risk in patients with prostate cancer need to be measured more frequently andfor a shorter time. Therefore, models like Garvan calculator with both 5- and 10-year risk estimateshave to be developed for these patients.