Archives of Osteoporosis

, 13:38 | Cite as

Fracture risk prediction using FRAX in patients following hematopoietic stem cell transplantation

  • Xerxes Pundole
  • William A. Murphy
  • Chidinma C. Ebede
  • Erfan Karim
  • Srishti Manocha
  • Data Don-Pedro
  • Gabriela Rondon
  • Cheuk Hong Leung
  • Suyu Liu
  • Xianglin L. Du
  • Richard E. Champlin
  • Huifang LuEmail author
Original Article



We aimed to study the utility of the FRAX tool in predicting fractures in patient’s receiving a hematopoietic stem cell transplantation (HSCT). Our results indicate that the FRAX tool has modest fracture predictive ability in patients greater than 50 years of age at the time of HSCT.


Identifying patients at high risk of osteoporotic fractures following HSCT is challenging. We aimed to evaluate the utility of the FRAX tool at the time of HSCT in predicting fractures following transplant.


We conducted a retrospective chart review of adults (> 18 years) who underwent HSCT at MD Anderson Cancer Center from January 1, 2001, to December 31, 2010, and were followed until December 31, 2013, to identify osteoporotic fractures. Multivariate Cox regression models were built using FRAX score thresholds of low risk < 10%, medium risk 10 to 20%, and high risk > 20% probability of osteoporotic fracture.


We identified 5170 patients who had undergone HSCT, 10% of whom developed an osteoporotic fracture during a median follow-up of 3.2 years. In patients > 65 years of age, those with medium risk (hazard ratio (HR) 2.38, 95% confidence interval (CI) 1.27–4.47) and high risk (HR 3.41, 95% CI 1.73–6.75) had a greater probability of developing an osteoporotic fracture compared to those at low risk. Similar trends were seen in patients 50 to 65 years of age.


In patients greater than 50 years, the FRAX tool has modest predictive ability and could be used to aid in preventive treatment decision-making at the time of transplant.


Fracture Stem cell transplant FRAX Osteoporosis 



We thank Dr. John A. Kanis at The Centre for Metabolic Diseases, University of Sheffield Medical School, Sheffield, UK, for this input and advice. We also thank Ann Sutton in the Department of Scientific Publications at MD Anderson for providing editorial assistance.


This research was supported by funds from the University Cancer Foundation and Duncan Family Institute for Cancer Prevention and Risk Assessment via the Cancer Survivorship Research Seed Money Grants at The University of Texas MD Anderson Cancer Center, the John S. Dunn, Sr. Distinguished Chair in Diagnostic Imaging and was supported by a grant from the Rolanette and Berdon Lawrence Bone Disease Program of Texas. Statistical analyses were performed by the MD Anderson Cancer Center Biostatistics Resource Group, which is supported by the National Institutes of Health through MD Anderson’s Cancer Center Support Grant (P30CA016672).

Compliance with ethical standards

Institutional review board approval was obtained before any data were collected for this study. The use of patient information complied with the Health Insurance Portability and Accountability Act, and sensitive patient data were protected in the data analysis.

Conflicts of interest


Supplementary material

11657_2018_453_MOESM1_ESM.docx (16 kb)
ESM 1 (DOCX 15 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Xerxes Pundole
    • 1
  • William A. Murphy
    • 2
  • Chidinma C. Ebede
    • 1
  • Erfan Karim
    • 1
  • Srishti Manocha
    • 1
  • Data Don-Pedro
    • 1
  • Gabriela Rondon
    • 3
  • Cheuk Hong Leung
    • 4
  • Suyu Liu
    • 4
  • Xianglin L. Du
    • 5
  • Richard E. Champlin
    • 3
  • Huifang Lu
    • 1
    Email author
  1. 1.Department of General Internal Medicine, Section of Rheumatology and Clinical ImmunologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Diagnostic RadiologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of Stem Cell Transplantation and Cellular TherapyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonUSA
  5. 5.Department of Epidemiology, School of Public HealthUniversity of Texas Health Science CenterHoustonUSA

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