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Validation of Biomechanical Computed Tomography for Fracture Risk Classification in Metastatic Hormone-sensitive

John K Lin1, Caleb M Hearn2, Emily Getzen3

  • 1University of Texas MD Anderson Cancer Center, Houston, TX, USA.

European Urology Oncology
|November 5, 2023
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Summary

Biomechanical computed tomography (BCT) shows strong correlation with dual-energy x-ray absorptiometry (DXA) for bone density in men with metastatic hormone-sensitive prostate cancer. BCT can predict pathologic fractures and identify more patients eligible for bone-protective therapy.

Keywords:
Androgen deprivation therapyAntiresorptive therapyBiomechanical computed tomographyDual x-ray absorptiometryFractureProstate cancer

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Area of Science:

  • Radiology and Oncology
  • Bone Metabolism and Disease
  • Prostate Cancer Research

Background:

  • Guidelines recommend dual-energy x-ray absorptiometry (DXA) for fracture risk assessment in men with metastatic hormone-sensitive prostate cancer (mHSPC) on androgen deprivation therapy (ADT).
  • DXA screening is underutilized, with less than 30% of eligible patients undergoing the procedure.
  • Biomechanical computed tomography (BCT) offers a radiomic approach to measure bone mineral density (BMD) and strength from existing computed tomography (CT) scans.

Purpose of the Study:

  • To evaluate correlations between BCT- and DXA-assessed BMD.
  • To assess associations between BCT-derived metrics and subsequent fracture risk in mHSPC patients.

Main Methods:

  • A multicenter retrospective cohort study included 91 patients with mHSPC diagnosed between 2013 and 2020.
  • CT scans obtained within 48 weeks before ADT initiation and during follow-up were analyzed using BCT.
  • Univariate logistic regression analyzed associations between BCT measurements and pathologic/nonpathologic fractures.

Main Results:

  • BCT and DXA femoral-neck BMD T-scores demonstrated a strong correlation (R² = 0.93).
  • Lower baseline BCT-assessed BMD was associated with an increased risk of pathologic fracture (OR 1.80, p=0.03).
  • BCT identified 9.9% of patients eligible for antiresorptive therapy who were not previously identified or treated.

Conclusions:

  • BCT assessments correlate strongly with DXA measurements in mHSPC patients.
  • BCT can predict subsequent pathologic fractures.
  • BCT facilitates broader fracture risk assessment and identifies additional candidates for antiresorptive therapy, potentially improving bone health management.