SAGE-Hindawi Access to Research Journal of Osteoporosis Volume 2011, Article ID 924595, 6 pages doi:10.4061/2011/924595 Clinical Study Predictors of Fracture Risk and Bone Mineral Density in Men with Prostate Cancer on Androgen Deprivation Therapy Katherine Neubecker,1 Beverley Adams-Huet,2 Irfan M. Farukhi,3 Rosinda C. Delapena,3 and Ugis Gruntmanis4 1 Department of Medicine, University of Texas, Southwestern Medical Center, Dallas, TX 75390, USA 2 Departments of Clinical Sciences and Medicine, University of Texas, Southwestern Medical Center, Dallas, TX 75390, USA 3 Department of Nuclear Medicine, Dallas Veterans Aﬀairs Medical Center, Dallas, TX 75216, USA 4 Department of Medicine, Dallas Veterans Aﬀairs Medical Center and University of Texas, Southwestern Medical Center, Dallas, TX 75216, USA Correspondence should be addressed to Ugis Gruntmanis, ugis.gruntmanis@utsouthwestern.edu Received 8 March 2011; Revised 26 April 2011; Accepted 9 May 2011 Academic Editor: Pawel Szulc Copyright © 2011 Katherine Neubecker et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Decrease of bone mineral density (BMD) and fracture risk is increased in men with prostate cancer receiving androgen deprivation therapy (ADT). We looked at possible predictors of decreased BMD and increased fracture risk in men with prostate cancer; most of whom were on ADT. In a retrospective study, we analyzed serum, BMD, and clinical risk factors used in the Fracture Risk Assessment (FRAX) tool and others in 78 men with prostate cancer with reported height loss. The subjects were divided in two groups: 22 men with and 56 without vertebral fractures. 17 of the 22 men with vertebral fractures on spine X-rays did not know they had a vertebral fracture. Of those 17 men, 9 had not previously qualiﬁed for treatment based on preradiograph FRAX score calculated with BMD, and 6 based on FRAX calculated without BMD. Performing spine ﬁlms increased the predictive ability of FRAX for vertebral fracture. Vertebral fracture was better predicted by FRAX for other osteoporotic fractures than FRAX for hip fractures. The inclusion of BMD in FRAX calculations did not aﬀect the predictive ability of FRAX. The PSA level showed a positive correlation with lumbar spine BMD and accounted for about 9% of spine BMD. 1. Introduction 220,000 men are diagnosed with prostate cancer each year, and more than 40 percent receive androgen deprivation therapy (ADT) as initial treatment [1, 2]. ADT has been shown to decrease bone mineral density (BMD) as measured by dual-energy X-ray absorptiometry (DXA) as well as increase risk of fracture. After initiating ADT, BMD decline starts shortly after [3, 4]. A meta-analysis of almost 117,000 men demonstrated that patients on ADT had lower total BMD, 30% increased risk of osteoporosis, and 70% increased risk of fractures [5]. In a study of over 47,000 men with prostate cancer by the National Cancer Institute (NCI) and Medicare, those treated with ADT or bilateral orchiectomy within six months of diagnosis had a 5-year fracture risk of 19.4% versus 12.6% in controls matched for patient and tumor characteristics [6]. A systematic review of ﬁve studies on prostate cancer patients in the US and abroad, which included the NCI-Medicare study, found a 23% increase in fracture risk for men treated with ADT [7]. Fracture Risk Assessment (FRAX) is an algorithm devel- oped by the World Health Organization to determine fracture risk of men and women [8]. The risk factors in the algorithm include age, current height, prior fracture, parental history of fracture, BMD of the femoral neck, and secondary osteoporosis risk factors such as hypogonadism. Yet, inclusion of secondary causes such as hypogonadism does not change FRAX-calculated risk of fracture when femoral neck BMD is included. The National Osteoporosis Foundation’s recommended treatment thresholds based on FRAX score are 3% for hip (“Hip FRAX”) and 20% for major osteoporotic fractures (“Osteoporotic FRAX”) [9].