Longitudinal Evaluation of Bone Mineral Density and Bone Metabolism Markers in Patients with Indolent Systemic Mastocytosis Without Osteoporosis

Abstract

Systemic Mastocytosis has been long identified as a potential cause of osteoporosis; nevertheless, data regarding longitudinal variation of bone mineral density (BMD) in patients with indolent systemic mastocytosis (ISM) are missing . We studied BMD variation at lumbar spine and proximal hip after 30-month (±6 months) follow-up in a large cohort of patients (83) with ISM without osteoporosis, supplementated with vitamin D and/or calcium when needed. We also analyzed the correlation between variation of BMD, basal serum tryptase levels and bone turnover markers (BTM). Sixty-four percent of our population was male; mean age was 52.1 (±11.5) years. Vitamin D insufficiency (serum levels of 25-OH-vitamin D, 25OHD, lower than 75 nmol/L) was found in more than 70 % of patients. After a follow-up of 30 ± 6 months with only vitamin D (5000-7500 IU weekly of oral cholecalciferol) or calcium (500 mg/die) supplementation when needed, we observed 2.1 % increase in BMD at lumbar spine, with no significant changes at hip. At the end of follow-up, almost 60 % of patients showed 25OHD serum levels still lower than recommended, despite vitamin D supplementation. Reduction in BMD after follow-up significantly correlated with high C-telopeptide of type I collagen serum levels at the time of diagnosis. In patients with ISM without osteoporosis, a routinary BMD evaluation within a time <2 years is not justified, except in the presence of elevated BTM. In these patients, vitamin D supplementation is frequently needed.

Lower prevalence of vitamin D insufficiency in German patients with systemic mast cell activation syndrome compared with the general population

“…Our findings are in principle similar to those reported by Guillaume et al [17] for patients with SM (the rare variant of mastocytosis; ▶ Table 1): the mean (± SD) vitamin D level in SM patients amounted to 26.6 ± 17.3 ng/mL (n = 45), which was higher than that in healthy individuals (20.1 ± 5.9 ng/ mL; n = 28). Also in a recent study on Italian SM patients without osteoporosis (n = 83), a vitamin D level less than > 30 ng/mL was determined in about 70 % of the patients [18]; this prevalence is lower than that for the Italian general population (82.2 %; n = 427; [19]). The question arises why in patients with an increased MC activity, both MCAS and SM, vitamin D levels are higher than in healthy controls, which at first sight would not be expected because of, for example, the high prevalence of osteopenia, osteoporosis, osteolytic lesions, and osteosclerosis in MCAD patients (> 50 %; [20,21]; further references therein).…”

Mast Cells and Vitamin D Status: A Clinical and Biological Link in the Onset of Allergy and Bone Diseases

“…In a group of patients suffering from ISM without osteoporosis, Artuso et al studied BMD change at the lumbar spine and proximal hip before and after VD supplementation [ 101 ]. Furthermore, they investigated the possible relationships between BMD changes and serum tryptase concentrations.…”

“…After 30 months with VD (or calcium supplement when necessary), they reported a 2.1% increase in BMD at the lumbar spine, while no variations were detected at hip. However, after 30 months, about 60% of subjects presented VD concentrations that were still lower than recommended [ 101 ].…”