title: Lumbar bone mineral density as the major factor determining increased prevalence of vertebral fractures in monoclonal gammopathy of undetermined significance.
abstract: The possible relationships between biochemical measurements and both densitometric and radiographic indexes of skeletal fragility were evaluated in 65 postmenopausal women with monoclonal gammopathy of undetermined significance (MGUS). There was a significantly higher prevalence of vertebral fractures in the MGUS group compared with a control population (P < or = 0.001). The MGUS patients were then grouped according to the presence or absence of at least one mild vertebral fracture. Patients with fractures (Fx, n=34) were older (62.8 +/- 6.1 years), with long-standing disease (8.8 +/- 7.1 years) when compared with those without fractures (NFx, n=31; 59.7 +/- 5.0 years, P < or = 0.05 and 5.8 +/- 4.1 years, P < or = 0.05). The receptor activator of nuclear factor kappa-B ligand/osteoprotegerin ratio was higher in Fx compared with NFx (0.092 +/- 0.018 vs. 0.082 +/- 0.020; P < or = 0.05). Lumbar spine (0.811 +/- 0.14 vs. 0.956 +/- 0.12 g/cm2), femoral neck (0.660 +/- 0.09 vs. 0.747 +/- 0.10 g/cm2) and total bone mineral density (BMD) (0.788 +/- 0.11 vs. 0.884 +/- 0.11 g/cm2) were lower (all P < or = 0.001) in FxMGUS compared with Nfx patients. Receiver operating characteristic curves identified lumbar BMD as the variable that best predicted vertebral fractures (area under the curve 0.817; 95% confidence interval, 0.713-0.921). This study provides an indication for the measurement of BMD in MGUS patients, as a means of predicting vertebral fractures, especially in those that are asymptomatic. Patients with prevalent fractures should undergo pharmacological treatment to prevent further fractures.
authors.affiliation: Dipartimento di Scienze Cliniche, Università La Sapienza, Rome, Italy.
authors.forename: Jessica
authors.initials: J
authors.lastname: Pepe
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Petrucci
authors.forename: Italo
authors.initials: I
authors.lastname: Nofroni
authors.forename: Valeria
authors.initials: V
authors.lastname: Fassino
authors.forename: Daniele
authors.initials: D
authors.lastname: Diacinti
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Romagnoli
authors.forename: Salvatore
authors.initials: S
authors.lastname: Minisola
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015519:Bone Density; D016723:Bone Remodeling; D002352:Carrier Proteins / Q000097:blood; D005260:Female; D005272:Femur Neck; D006023:Glycoproteins / Q000097:blood; D006615:Hip; D006801:Humans; D016014:Linear Models; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008562:Membrane Glycoproteins / Q000097:blood; D008875:Middle Aged; D008998:Monoclonal Gammopathy of Undetermined Significance / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D009333:Neck; D015663:Osteoporosis, Postmenopausal / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D053244:Osteoprotegerin; D015995:Prevalence; D053245:RANK Ligand; D012372:ROC Curve; D053246:Receptor Activator of Nuclear Factor-kappa B; D018160:Receptors, Cytoplasmic and Nuclear / Q000097:blood; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*
chemical_list: D015415:Biomarkers; D002352:Carrier Proteins; D006023:Glycoproteins; D008562:Membrane Glycoproteins; D053244:Osteoprotegerin; D053245:RANK Ligand; D053246:Receptor Activator of Nuclear Factor-kappa B; D018160:Receptors, Cytoplasmic and Nuclear; D018124:Receptors, Tumor Necrosis Factor; C505686:TNFRSF11A protein, human; C506030:TNFRSF11B protein, human; C505688:TNFSF11 protein, human