Risk Assessment Tool Stratifies Major Osteoporotic Fracture Risk in Prostate Cancer

The Fracture Risk Assessment Tool (FRAXÒ) is an easy to complete questionnaire for identifying fracture risk among patients initiating androgen deprivation therapy (ADT) for prostate cancer. These findings were published in Archives of Osteoporosis.

In prostate cancer, ADT is associated with increased risk for osteoporosis and skeletal fractures. As such, the National Institute for Health and Care Excellence (NICE) recommends patients with prostate cancer be evaluated for bone-related health, but fracture risk is often overlooked in this population.

The goal of this study was to evaluate the utility of the fracture risk tool in the setting of prostate cancer. A total of 200 men starting long-term ADT between 2020 and 2022 at The Royal Bolton Hospital in the United Kingdom completed the FRAX questionnaire and were assessed for serum vitamin D and calcium levels. The primary outcome was the 10-year probability of sustaining a major osteoporotic fracture (MOF).

The patients were median age 73.5 years (range, 54 to 89).

Ten-year probability of sustaining a MOF ranged between 3.1% and 54% and the 10-year probability of sustaining a hip fracture ranged between 0.2% and 52%.

Risk for sustaining a MOF was low for 91% of patients, intermediate for 6%, and high for 3%. In the high-risk group, all 6 patients had a previous fracture, 4 had a parental fracture history, and 3 consumed 3 or more units of alcohol per day.

All patients had normal calcium levels, whereas 35.5% had deficient vitamin D levels (<25 nmol/L), 31.5% had insufficient levels (25-50 nmol/L), and 33% had normal levels (>50 nmol/L).

This study may have been limited by its definition of normal vitamin D levels, which is lower than some studies.

These data indicated that the FRAX assessment was simple and identified patients at risk for fracture, making it a useful tool in the setting of prostate cancer.


Sharqawi A, Hewitt K, Alexander C, El-Sakka AI, Lee L. Improving bone health in prostate cancer patients starting androgen deprivation therapy: does Fracture Risk Assessment Tool (FRAX®) enhance stratification and targeted management? Arch Osteoporos. 2022;17(1):143. doi:10.1007/s11657-022-01185-8

This article originally appeared on Oncology Nurse Advisor