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Risk assessment of femoral pathological fracture in prostate cancer patients by computed tomography analysis

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Abstract

Introduction

Prostate cancer often forms osteoblastic lesions that appear as a high-dense shadow upon X-ray. Although the lesions may seem to increase bone strength, pathological fracture occurs in one in four patients with prostate cancer. The aim of this study is to elucidate the factors that may increase the risk of pathological fracture in patients with prostate cancer metastases in the proximal femur by analyzing computed tomography data.

Materials and methods

Computed tomography data of the femur of 62 prostate cancer patients were retrospectively analyzed. The patients were divided into three groups based on the presence or absence of femoral metastatic lesions and pathological fracture. Surgical specimens of the proximal femur collected from patients who had a pathological fracture were histologically analyzed.

Results

Bone density in the marrow area was increased in all cases with metastases compared with those with no metastases. Contrarily, the cortical bone density at the medial trochanter region was significantly lower in patients who had pathological fractures in the proximal femur than those who did not. Accordingly, histological analysis of the surgical specimens revealed that the affected cortical bone was osteopenic without any apparent new bone formation.

Conclusion

These results indicate that prostate cancer is less effective in inducing bone formation in the cortex than in the marrow and that the decrease in the cortical bone density at the medial trochanter region leads to an increased risk of pathological fracture. Therefore, a previously undocumented risk factor for pathological fracture in prostate cancer patients is presented.

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Acknowledgements

The authors would like to thank Takemi Oguma (Department of Orthopedic Surgery, National Defense Medical College), Ruu Hokari (Department of Basic Pathology, National Defense Medical College), Fumiko Hamabe, Ayako Mikoshi (Department of Radiology, National Defense Medical College), and Shinsuke Tasaki (Department of Urology, National Defense Medical College) for their technical assistance.

Funding

Japan Society for the Promotion of Science, 9K09613, Kazuhiro Chiba

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Authors and Affiliations

  1. Department of Orthopedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan

    Hajime Rikitake, Keisuke Horiuchi, Michiro Susa, Masahiro Inoue, Eiko Taguchi, Takahiro Ishizaka & Kazuhiro Chiba

  2. Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan

    Keisuke Horiuchi

  3. Department of Pathology, Japan Self-Defense Forces Central Hospital, Tokyo, 154-0001, Japan

    Kosuke Miyai

Authors
  1. Hajime Rikitake
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  2. Keisuke Horiuchi
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  3. Kosuke Miyai
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  4. Michiro Susa
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  5. Masahiro Inoue
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  6. Eiko Taguchi
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  7. Takahiro Ishizaka
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  8. Kazuhiro Chiba
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Contributions

HR: designed the study, performed most of the experiments, analyzed the data, and wrote the manuscript. KH: supervised the project, designed the study, and wrote the manuscript. MS and KC: supervised the project. MI, ET, and TI: assisted with the analysis.KM: performed the histological analysis.

Corresponding author

Correspondence to Keisuke Horiuchi.

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Rikitake, H., Horiuchi, K., Miyai, K. et al. Risk assessment of femoral pathological fracture in prostate cancer patients by computed tomography analysis. J Bone Miner Metab 40, 704–711 (2022). https://doi.org/10.1007/s00774-022-01338-2

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  • DOI: https://doi.org/10.1007/s00774-022-01338-2

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