Guillermina Orduna1, Leonardo Mellibovsky1, Eugenia Abella2, Xavier Nogués3, Roser Granero4, Natalia García-Giralt1, Marta Pineda-Moncusí1, Roberto Güerri-Fernández1, Daniel Prieto-Alhambra5, Adolfo Díez-Pérez1. 1. Department of Internal Medicine, Musculoskeletal Research Group, Hospital del Mar-IMIM, Department of Medicine, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain. 2. Department of Hematology, Hospital del Mar, Barcelona, Spain. 3. Department of Internal Medicine, Musculoskeletal Research Group, Hospital del Mar-IMIM, Department of Medicine, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain. xnogues@hospitaldelmar.cat. 4. Department of Psychobiology and Methodology, Autonomous University of Barcelona, Barcelona, Spain. 5. Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom, and CIBERFES, Instituto Carlos III, Barcelona, Spain.
Abstract
INTRODUCTION: Monoclonal gammopathy of uncertain significance (MGUS) is highly prevalent in older adults and affects bone structure, with osteoporosis and increased risk of fractures in up to 14% of affected patients. Dual-energy X-ray absorptiometry (DXA), the standard technique for diagnosing osteoporosis, is ineffective to reveal microstructure and bone quality in this disease. MATERIALS AND METHODS: We conducted a cross-sectional study of patients with MGUS, recruited consecutively from the Hematology and Internal Medicine Departments of Hospital del Mar, Barcelona, between January 2011 and January 2018. Medical records, clinical results and spinal X-ray images were collected. Bone mineral density (BMD) at hip and spine was measured by DXA and Bone Material Strength index (BMSi) by impact microindentation on the tibial mid-shaft. RESULTS: Thirty-nine patients with MGUS and 65 age-matched controls without previous fractures were included. In the MGUS group, 11 (28.2%) patients had prevalent fractures, nearly half of them vertebral (n = 5, 45.45%). Compared to controls, MGUS patients had significantly lower BMSi, a mean (SD) of 70.72 (9.70) vs. 78.29 (8.70), p = 0.001, and lower spinal BMD values (0.900 [0.159] vs. 1.003 [0.168], respectively, p = 0.012), but no significant differences at femoral neck and total hip. No association was observed between BMSi and DXA. Bone remodeling markers (procollagen type-1 N propeptide, bone-alkaline phosphatase and C-terminal telopeptide of type I collagen) did not differ between the two groups. CONCLUSIONS: Spinal BMD and mechanical properties of bone tissue, as measured by impact microindentation, were impaired in patients with MGUS. These changes in bone tissue mechanical resistance were independent of DXA levels.
INTRODUCTION: Monoclonal gammopathy of uncertain significance (MGUS) is highly prevalent in older adults and affects bone structure, with osteoporosis and increased risk of fractures in up to 14% of affected patients. Dual-energy X-ray absorptiometry (DXA), the standard technique for diagnosing osteoporosis, is ineffective to reveal microstructure and bone quality in this disease. MATERIALS AND METHODS: We conducted a cross-sectional study of patients with MGUS, recruited consecutively from the Hematology and Internal Medicine Departments of Hospital del Mar, Barcelona, between January 2011 and January 2018. Medical records, clinical results and spinal X-ray images were collected. Bone mineral density (BMD) at hip and spine was measured by DXA and Bone Material Strength index (BMSi) by impact microindentation on the tibial mid-shaft. RESULTS: Thirty-nine patients with MGUS and 65 age-matched controls without previous fractures were included. In the MGUS group, 11 (28.2%) patients had prevalent fractures, nearly half of them vertebral (n = 5, 45.45%). Compared to controls, MGUS patients had significantly lower BMSi, a mean (SD) of 70.72 (9.70) vs. 78.29 (8.70), p = 0.001, and lower spinal BMD values (0.900 [0.159] vs. 1.003 [0.168], respectively, p = 0.012), but no significant differences at femoral neck and total hip. No association was observed between BMSi and DXA. Bone remodeling markers (procollagen type-1 N propeptide, bone-alkaline phosphatase and C-terminal telopeptide of type I collagen) did not differ between the two groups. CONCLUSIONS: Spinal BMD and mechanical properties of bone tissue, as measured by impact microindentation, were impaired in patients with MGUS. These changes in bone tissue mechanical resistance were independent of DXA levels.
Entities:
Keywords:
Bone microindentation; Bone quality; DXA; Monoclonal gammopathy of uncertain significance
Authors: M Roussou; A Tasidou; M A Dimopoulos; E Kastritis; M Migkou; D Christoulas; M Gavriatopoulou; F Zagouri; C Matsouka; D Anagnostou; E Terpos Journal: Leukemia Date: 2009-07-09 Impact factor: 11.528
Authors: Sigurdur Y Kristinsson; Min Tang; Ruth M Pfeiffer; Magnus Björkholm; Cecilie Blimark; Ulf-Henrik Mellqvist; Anders Wahlin; Ingemar Turesson; Ola Landgren Journal: Blood Date: 2010-07-07 Impact factor: 22.113
Authors: Alvin C Ng; Sundeep Khosla; Natthinee Charatcharoenwitthaya; Shaji K Kumar; Sara J Achenbach; Margaret F Holets; Louise K McCready; L Joseph Melton; Robert A Kyle; S Vincent Rajkumar; Matthew T Drake Journal: Blood Date: 2011-10-31 Impact factor: 22.113
Authors: Terry M Therneau; Robert A Kyle; L Joseph Melton; Dirk R Larson; Joanne T Benson; Colin L Colby; Angela Dispenzieri; Shaji Kumar; Jerry A Katzmann; James R Cerhan; S Vincent Rajkumar Journal: Mayo Clin Proc Date: 2012-08-07 Impact factor: 7.616