Development and validation of a prognostic index for fracture risk in older men undergoing prostate cancer treatment

Abstract

Objectives Men treated with androgen deprivation therapy (ADT) or radiation therapy (RT) for prostate cancer have an increased risk for fractures. Given uncertainty as to whether specific clinical factors can identify men at increased risk, we sought to develop a prognostic index for risk of fracture in this population. Materials and methods We used the Surveillance, Epidemiology, and End Results-Medicare database to identify men who received ADT or RT after being diagnosed with localized prostate cancer in 2007-2009. Cox proportional hazards models tested the association of potential risk factors with fracture. In a derivation group, hazard ratios were used to assign points for factors independently related to fracture. The prognostic index was then applied to a validation group. Results The sample of 5,824 men had a median age of 73.0 years; 82.9% were white and 8.6% had a fracture within 2 years of treatment for prostate cancer. The Cox model identified 8 variables (age, race, hormone treatment, Elixhauser score, anxiety, Parkinson's, fall-inducing medications and disability status) independently associated with fracture. In the derivation cohort, 4.3% of the sample experienced a fracture in the low-risk group, 8.9% in the intermediate group, and 19.2% in the high-risk group (C statistic, 0.749). The index was applied to the validation cohort (C statistic, 0.782). Conclusion The prognostic index can help to identify patients at increased risk for fracture. This underscores the importance of identifying risk factors for fracture, given the substantial variation in fracture risk in men treated with ADT or RT.

Efficacy and safety of darolutamide in Japanese patients with nonmetastatic castration-resistant prostate cancer: a sub-group analysis of the phase III ARAMIS trial

“…The higher incidence of fractures associated with darolutamide in the Japanese subgroup may be related to more elderly patients (aged ≥ 85 years) in the darolutamide group as compared with the placebo group (19.4 vs. 6.1%), since advanced age is a significant risk factor for fracture in men with prostate cancer [41,42]. In addition, the longer duration of prior ADT in the darolutamide group may have contributed to the higher incidence of fractures, consistent with previous studies demonstrating an association between duration of ADT and fracture risk in both Western and Japanese [41,[43][44][45][46]. As ADT-related fracture risk also may increase with advancing age [47], an additive effect may have been induced by the higher proportion of patients aged ≥ 85 years combined with greater exposure to ADT in the darolutamide group.…”

In-Hospital Fall and Fracture Risk With Conditions in the Elixhauser Comorbidity Index: An Analysis of State Inpatient Data

“…The Elixhauser Comorbidity Index has been associated with a greater risk of fracture among prostate cancer treatment patients 13 and readmission of trauma patients within 1 year of admission to a regional trauma center 14 . These studies suggest that some health conditions from the Elixhauser Comorbidity Index may be valuable in identifying individuals at risk of an IHF.…”

“…12 This is expected because the Elixhauser Comorbidity Index focuses on inpatient events rather than the outcome of 1-year mortality used to build the Charlson Comorbidity Index. 11 The Elixhauser Comorbidity Index has been associated with a greater risk of fracture among prostate cancer treatment patients 13 and readmission of trauma patients within 1 year of admission to a regional trauma center. 14 These studies suggest that some health conditions from the Elixhauser Comorbidity Index may be valuable in identifying individuals at risk of an IHF.…”

Managing an Older Adult with Cancer: Considerations for Radiation Oncologists

“…One study found that a Vulnerable Elders Survey-13 (VES-13) score above 7 was associated with around 3 times greater probability for not completing a radiation treatment [ 108 ]. A prognostic index consisting of demographics, medication and hormone use, comorbidities, anxiety, and functional status was validated for patients with prostate cancer who underwent androgen deprivation therapy and/or radiation therapy [ 109 ]. Patients determined to be high-risk by the prognostic index had a significantly higher risk for fracture rate (19.2% in derivation cohort, 16.5% in validation cohort).…”