Vertebral Fractures and Trabecular Microstructure in Men With Prostate Cancer on Androgen Deprivation Therapy
Vertebral Fractures and Trabecular Microstructure in Men With Prostate Cancer on Androgen Deprivation Therapy
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DOI：
10.1002/jbmr.1771
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发表时间：
2013-02-01
影响因子：
6.2
通讯作者：
Resnick, Neil M.
中科院分区：
文献类型：
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作者：
Greenspan, Susan L.;Wagner, Julie;Resnick, Neil M.
雄激素剥夺疗法（ADT）是一种治疗前列腺癌的方法，与骨质流失和骨折有关。双能X线骨密度仪（DXA）测量的骨密度不能评估椎体骨折（VF）。高分辨率微磁共振成像（HR-MRI）评估骨微结构并提供结构信息。为了确定VF识别是否增加了DXA以外的骨质疏松症的诊断，以及HR-MRI是否显示VF男性的骨骼恶化，我们对137名年龄>60岁的非转移性前列腺癌男性进行了为期6个月的ADT横断面研究。通过DXA进行的椎体骨折评估（VFA）经X线证实。腕关节HR-MRI包括骨体积/总体积（BV/TV）、表面密度（骨小梁板）、表面/弯曲比（板/棒）和侵蚀指数（较高表示恶化）。VF在37%的男性中被发现;大多数是未知的。百分之七的参与者被归类为髋关节或脊柱DXA。37%的DXA检查无骨质疏松症的男性有VF，这表明90%的临床骨质疏松症患者可能被DXA单独错误分类。通过对VF分级的方差分析比较，中重度VF患者的BV/TV、表面密度、脊柱、髋关节和腕关节DXA较低，而糜烂指数较高（均为P <0.05）。
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