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Radiotherapy related insufficiency fractures and bone mineral density - what is the connection?
Chatzimavridou Grigoriadou, Victoria Barraclough, Lisa H Kochhar, Rohit Buckley, Lucy Alam, Nooreen Higham, Claire E
Chatzimavridou Grigoriadou, Victoria
Barraclough, Lisa H
Kochhar, Rohit
Buckley, Lucy
Alam, Nooreen
Higham, Claire E
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Abstract
Background: Radiotherapy-related insufficiency fractures (RRIFs) represent a common, burdensome consequence of pelvic radiotherapy. Their underlying mechanisms remain unclear and data on the effect of osteoporosis are contradictory, with limited studies assessing BMD by DXA.
Methods: BMD by DXA (Hologic) scan and fracture risk (FRAX) following pelvic RRIF were retrospectively assessed in 39 patients (median age 68 years), at a tertiary cancer centre. Patient characteristics and treatment history are presented narratively; correlations were explored using univariate regression analyses.
Results: Additional cancer treatments included chemotherapy (n=31), surgery (n=20), brachytherapy (n=19). Median interval between initiation of radiotherapy and RRIF was 11 [7.5-20.8] and between RRIF and DXA 3 [1-6] months. Three patients had normal BMD, 16 had osteopenia and 16 osteoporosis, following WHO classification. Four patients were <40 years at time of DXA (all Z-scores>-2). Median 10-year risk for hip and major osteoporotic fracture were 3.1% [1.5-5.7] and 11.5% [7.1-13.8], respectively. Only 33.3% of patients had high fracture risk (hip fracture >4% and/or major osteoporotic >20%), and 31% fell above the intervention threshold per NOGG guidance (2017). Higher BMD was predicted by lower pelvic radiotherapy dose (only in L3, L4), concomitant chemotherapy and higher body mass index.
Conclusion: At the time of RRIF, most patients did not have osteoporosis, some had normal BMD, and overall had low fracture risk. Whilst low BMD is a probable risk factor, it is unlikely to be the main mechanism underlying RRIFs and further studies are required to understand the predictive value of BMD.
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2023
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Chatzimavridou Grigoriadou V, Barraclough LH, Kochhar R, Buckley L, Alam N, Higham CE. Radiotherapy related insufficiency fractures and bone mineral density - what is the connection? Endocr Connect. 2023 Apr 1. PubMed PMID: 37097164. Epub 2023/04/25. eng.