Factors associated with an increased risk of vertebral fracture in monoclonal gammopathies of undetermined significance

Abstract

Monoclonal gammopathies of undetermined significance (MGUS) have been shown to be associated with an increased risk of fractures. This study describes prospectively the bone status of MGUS patients and determines the factors associated with vertebral fracture. We included prospectively 201 patients with MGUS, incidentally discovered, and with no known history of osteoporosis: mean age 66.6±12.5 years, 48.3% women, 51.7% immunoglobulin G (IgG), 33.3% IgM and 10.4% IgA. Light chain was kappa in 64.2% patients. All patients had spinal radiographs and bone mineral density measurement in addition to gammopathy assessment. At least one prevalent non-traumatic vertebral fracture was discovered in 18.4% patients and equally distributed between men and women. Fractured patients were older, had a lower bone density and had also more frequently a lambda light chain isotype. Compared with patients with κ light chain, the odds ratio of being fractured for patients with λ light chain was 4.32 (95% confidence interval 1.80–11.16; P=0.002). These results suggest a high prevalence of non-traumatic vertebral fractures in MGUS associated with lambda light chain isotype and not only explained by low bone density.

Bone disease in monoclonal gammopathy of undetermined significance: results from a screened population-based study

“…This is consistent with earlier findings that have shown a higher relative risk of fractures in men with MGUS than in women, 4 and that men with MGUS have an unexpected high prevalence of vertebral fractures. 32 In postmenopausal women, the generally enhanced rate of bone loss may mask the effect of MGUS on bone metabolism. 22 Further analysis on the MGUS individuals who developed fractures showed Table 2.…”

Monoclonal gammopathy of undetermined significance and bone health outcomes: a systematic review and exploratory meta-analysis

“…The search identified 184 non duplicate potentially eligible studies. After excluding 164 papers through title and abstract review and 10 from full text examination, 10 studies [10][11][12][13][14][15][16][17][18][19] were included ( Supplementary Figure 1). 6…”

“…Four studies [12][13][14][15] reported an overall prevalence of fractures of 14% (95%CI: 3-52) in MGUS participants, while the prevalence of osteoporosis in 3 studies [12,13,19] was 14% (95%CI:2-62) ( Supplementary Figures 1-2). Table 1, BMD (lumbar spine, hip and femoral neck) and T-scores (lumbar spine and hip) were not different between MGUS and controls.…”

Advanced Imaging of Multiple Myeloma Bone Disease

“…In retrospective studies, MGUS is associated with a 6 times greater risk of vertebral fracture and 1.4–2.5 times greater risk of any fracture when compared to control populations ( 11 , 18 ). Limited prospective evaluations of skeletal abnormalities in MGUS have been completed to date, but those that have confirm the high prevalence of vertebral fractures in MGUS and suggest an association between non-traumatic vertebral fractures and a clonal lambda light chain predominance ( 19 ). MGUS and SMM are associated with osteopenia, altered bone microstructure, and an increased rate of bone resorption and overall fracture risk ( 11 , 12 , 20 ).…”