Fracture risk prediction using FRAX in patients following hematopoietic stem cell transplantation
- 104 Downloads
We aimed to study the utility of the FRAX tool in predicting fractures in patient’s receiving a hematopoietic stem cell transplantation (HSCT). Our results indicate that the FRAX tool has modest fracture predictive ability in patients greater than 50 years of age at the time of HSCT.
Identifying patients at high risk of osteoporotic fractures following HSCT is challenging. We aimed to evaluate the utility of the FRAX tool at the time of HSCT in predicting fractures following transplant.
We conducted a retrospective chart review of adults (> 18 years) who underwent HSCT at MD Anderson Cancer Center from January 1, 2001, to December 31, 2010, and were followed until December 31, 2013, to identify osteoporotic fractures. Multivariate Cox regression models were built using FRAX score thresholds of low risk < 10%, medium risk 10 to 20%, and high risk > 20% probability of osteoporotic fracture.
We identified 5170 patients who had undergone HSCT, 10% of whom developed an osteoporotic fracture during a median follow-up of 3.2 years. In patients > 65 years of age, those with medium risk (hazard ratio (HR) 2.38, 95% confidence interval (CI) 1.27–4.47) and high risk (HR 3.41, 95% CI 1.73–6.75) had a greater probability of developing an osteoporotic fracture compared to those at low risk. Similar trends were seen in patients 50 to 65 years of age.
In patients greater than 50 years, the FRAX tool has modest predictive ability and could be used to aid in preventive treatment decision-making at the time of transplant.
KeywordsFracture Stem cell transplant FRAX Osteoporosis
We thank Dr. John A. Kanis at The Centre for Metabolic Diseases, University of Sheffield Medical School, Sheffield, UK, for this input and advice. We also thank Ann Sutton in the Department of Scientific Publications at MD Anderson for providing editorial assistance.
This research was supported by funds from the University Cancer Foundation and Duncan Family Institute for Cancer Prevention and Risk Assessment via the Cancer Survivorship Research Seed Money Grants at The University of Texas MD Anderson Cancer Center, the John S. Dunn, Sr. Distinguished Chair in Diagnostic Imaging and was supported by a grant from the Rolanette and Berdon Lawrence Bone Disease Program of Texas. Statistical analyses were performed by the MD Anderson Cancer Center Biostatistics Resource Group, which is supported by the National Institutes of Health through MD Anderson’s Cancer Center Support Grant (P30CA016672).
Compliance with ethical standards
Institutional review board approval was obtained before any data were collected for this study. The use of patient information complied with the Health Insurance Portability and Accountability Act, and sensitive patient data were protected in the data analysis.
Conflicts of interest
- 1.McClune B, Majhail NS, Flowers ME (2012) Bone loss and avascular necrosis of bone after hematopoietic cell transplantation. Semin Hematol 49(1):59–65. https://doi.org/10.1053/j.seminhematol.2011.10.007 CrossRefPubMedGoogle Scholar
- 2.Savani BN (2012) How can we improve life expectancy and quality of life in long-term survivors after allogeneic stem cell transplantation? Semin Hematol 49(1):1–3. https://doi.org/10.1053/j.seminhematol.2011.10.014 CrossRefPubMedGoogle Scholar
- 7.Wainwright SA, Marshall LM, Ensrud KE, Cauley JA, Black DM, Hillier TA, Hochberg MC, Vogt MT, Orwoll ES, Study of Osteoporotic Fractures Research G (2005) Hip fracture in women without osteoporosis. J Clin Endocrinol Metab 90(5):2787–2793. https://doi.org/10.1210/jc.2004-1568 CrossRefPubMedGoogle Scholar
- 11.Ensrud KE, Lui LY, Taylor BC, Schousboe JT, Donaldson MG, Fink HA, Cauley JA, Hillier TA, Browner WS, Cummings SR, Study of Osteoporotic Fractures Research G (2009) A comparison of prediction models for fractures in older women: is more better? Arch Intern Med 169(22):2087–2094. https://doi.org/10.1001/archinternmed.2009.404 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Pundole X, Cheema HI, Petitto GS, Lopez-Olivo MA, Suarez-Almazor ME, Lu H (2017) Prevention and treatment of bone loss and fractures in patients undergoing a hematopoietic stem cell transplant: a systematic review and meta-analysis. Bone Marrow Transplant 52(5):663–670. https://doi.org/10.1038/bmt.2016.312 CrossRefPubMedGoogle Scholar
- 17.Mantel N (1966) Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep Part 1 50(3):163–170Google Scholar
- 19.Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, Fonseca R, Rajkumar SV, Offord JR, Larson DR, Plevak ME, Therneau TM, Greipp PR (2003) Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 78(1):21–33. https://doi.org/10.4065/78.1.21 CrossRefPubMedGoogle Scholar
- 22.Niederwieser D, Baldomero H, Szer J, Gratwohl M, Aljurf M, Atsuta Y, Bouzas LF, Confer D, Greinix H, Horowitz M, Iida M, Lipton J, Mohty M, Novitzky N, Nunez J, Passweg J, Pasquini MC, Kodera Y, Apperley J, Seber A, Gratwohl A (2016) Hematopoietic stem cell transplantation activity worldwide in 2012 and a SWOT analysis of the Worldwide Network for Blood and Marrow Transplantation Group including the global survey. Bone Marrow Transplant 51(6):778–785. https://doi.org/10.1038/bmt.2016.18 CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Rizzo JD, Wingard JR, Tichelli A, Lee SJ, Van Lint MT, Burns LJ, Davies SM, Ferrara JL, Socie G (2006) Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation: joint recommendations of the European Group for Blood and Marrow Transplantation, Center for International Blood and Marrow Transplant Research, and the American Society for Blood and Marrow Transplantation (EBMT/CIBMTR/ASBMT). Bone Marrow Transplant 37(3):249–261. https://doi.org/10.1038/sj.bmt.1705243 CrossRefPubMedGoogle Scholar