2 Prior studies of men with prostate cancer on ADT by Saylor et al. and Adler et al. [10, 11] demonstrated that the inclusion of BMD values in the FRAX calculation led to lower FRAX scores, and thus fewer people qualiﬁed for treatment. These studies also found that the majority of men who met treatment thresholds did so because of the hip FRAX rather than osteoporotic FRAX. Men younger than 70 [10] and of African-American ethnicity [11] were less likely to meet treatment thresholds. Prior studies have addressed factors that aﬀect treatment qualiﬁcations in men on ADT based on FRAX scores. The utility FRAX for predicting incidence of fracture in men with prostate cancer has yet to be determined. Many of vertebral fractures are clinically unrecognized due to lack of complaints, yet, they are strong predictors of future fractures at all sites. Two and half inches or greater height loss in men is associated with increased risk of vertebral compression fractures [12]. The utility of height loss in predicting vertebral fracture in men with prostate cancer has not been established. 2. Materials and Methods 2.1. Subjects. This was a retrospective study of 78 male patients with prostate cancer (median age 77: 55 Caucasian, 19 African-American, 3 Hispanic, and 1 Spanish) at the Dallas Veterans Aﬀair Medical center (DVAMC) approved by the Institutional Review Board of DVAMC, Dallas, Tex, USA. Subjects had been referred to the Osteoporosis Clinic by the Department of Urology for management of bone health, either while receiving ADT (N = 63) or before initiating ADT (N = 15). All men at DVAMC receiving ADT or about to initiate ADT are referred by Urology Department to Osteoporosis clinic regardless of whether they have history of osteoporosis. At initial visit at Osteoporosis clinic, spine X-rays are obtained on all patients whose measured height in clinic is at least one inch less than their self-reported young adult height. Inclusion criteria were height loss and having spine X-rays, which were performed near or at the time of the initial Osteoporosis Clinic visit. Height loss was determined by the height measured at the initial Osteoporosis Clinic visit compared to self-reported young adult height. Patients with pathologic fractures thought to be secondary to bone metastases were excluded. The primary outcome of the study was whether height loss predicted fracture and BMD in men with prostate cancer on ADT. Secondary endpoints: in how many men would FRAX score change with ﬁnding compression fracture on spine X-ray, and if the duration of ADT and level of prostate-speciﬁc antigen (PSA) could predict BMD and fractures at any site. 2.2. Statistical Analysis. Comparisons of subjects with and without vertebral fractures were made with the Wilcoxon Rank Sum test. Univariate associations between continuous variables were assessed with Spearman correlation coeﬃ- cients. Logistic regression analysis was used to assess pre- dictors of fractures and to estimate unadjusted and adjusted odds ratios for fracture risk. Multiple linear regression analysis was conducted to further evaluate the relationship Journal of Osteoporosis between spine BMD as the dependent variable and PSA while controlling for age, weight, and use of vitamin D supplements. Data with positively skewed distributions were log-transformed prior to parametric analysis. Statistical analysis was performed with SAS version 9.2 (SAS Institute, Cary, NC, USA). To assess the utility of FRAX scores in predicting of vertebral fractures, receiver operating characteristic (ROC) curves which plot 1-speciﬁcity versus the sensitivity of the diagnostic value of the model were constructed, and the area under these curves (AUC) and 95% conﬁdence intervals were calculated. An ROC AUC of 0.5 indicates chance performance, and an ROC AUC of 1.0 is the ideal, maximum AUC [13]. 2.3. Radiography/Laboratory Measurements. BMD of the fe- moral neck, total hip, and lumbar spine were measured by DXA (Hologic QDR 4500A, Waltham, Mass, USA) in the DVAMC Nuclear Medicine Department. The least signiﬁcant change in g/cm2 for regions of interest in grams per square centimeter was as follows lumbar spine 0.031, total hip 0.037, and femoral neck 0.029. Serum total testosterone was mea- sured by electrochemiluminescence immunoassay, alkaline phosphatase by the p-nitrophenyl phosphate method, 25- hydroxy vitamin D by liquid chromatography/tandem mass spectrometry, PTH by chemiluminescent immunoassay, and calcium by indirect potentiometry. Intra-assay coeﬃcients of variation for all of the assays were less than three percent, and interassay coeﬃcients of variation were less than 8 percent. 3. Results and Discussion At baseline, men with prostate cancer, with or without vertebral fracture, were not statistically diﬀerent, except for total testosterone levels and FRAX scores (Table 1). Testosterone levels between groups were statistically dif- ferent (P = 0.01), yet, levels in both groups were profoundly low. The FRAX scores for hip fractures and other osteo- porotic fractures were also statistically diﬀerent (Table 2), as expected, when men with vertebral fractures and no vertebral fractures were compared. None of the primary outcomes were positive. The mean diﬀerence of height loss between men with and without vertebral fractures group was only −0.19 cm (95% CI: −0.83 to 0.45). Degree of height loss did not predict either bone density or fractures at any site; risk of vertebral fracture based on height loss produced an odds ratio of 1.1 (95% CI: 0.76 to 1.65). This can likely be explained by our inclusion criteria. In our clinic we order spine X-rays in men who have lost more than one inch of height, and, therefore, we could not compare men with and without height loss. Yet, 17 of the 22 subjects with vertebral fractures had no known history of vertebral fracture until they were discovered incidentally on spine ﬁlms ordered due to a loss of height. Had these fractures not been detected by spine X- rays, nine (about 41%) of the 22 men with fractures would have not qualiﬁed for treatment based on FRAX calculated with BMD or six (about 27%) based on FRAX calculated without BMD.