title: Monoclonal gammopathy of undetermined significance and bone health outcomes: a systematic review and exploratory meta-analysis.
abstract: Monoclonal gammopathy of undetermined significance (MGUS) is a common condition in the elderly. A number of studies have investigated the relationship between MGUS and bone health outcomes including bone mineral density (BMD), osteoporosis and fractures, but no meta-analysis exists. We conducted a systematic review and exploratory meta-analysis comparing bone health outcomes in patients with MGUS. Two independent authors searched PubMed and Scopus from inception until 19 October 2016. A meta-analysis of cross-sectional and longitudinal studies investigating fractures and BMD was conducted. Standardised mean differences (SMD) ± 95% confidence intervals (CIs) were calculated for BMD, and risk ratios (RRs) were calculated for prevalent and incident fractures. Of 174 initial hits, 10 studies of moderate methodological quality were eligible, including 8711 individuals with MGUS vs. 52,865 controls. Compared to controls, subjects with MGUS showed significantly lower values for radial cortical volumetric BMD (1 study; SMD = -5.45, 95% CI: -7.24 to -3.66), but not at the lumbar spine, femoral neck or hip. The incidence of fractures was higher in people with MGUS (n = 7466) vs. controls (n = 52,304) (RR = 1.36, 95% CI 1.28-1.44, I2= 0%) over a median of 12.5-year follow-up. The incidence of vertebral fractures was particularly elevated (RR = 2.50, 95% CI 1.53-4.06) although limited to two studies. In conclusion, although with limitations, our preliminary meta-analysis suggests that patients with MGUS are at higher risk of fractures despite evidence for differences in BMD being equivocal. Future longitudinal research is required to confirm our findings and determine if fracture prevention interventions are warranted in people with MGUS.
authors.affiliation: Department of Medicine, Geriatrics Section, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy. ilmannato@gmail.com.
authors.forename: Nicola
authors.initials: N
authors.lastname: Veronese
authors.affiliation: Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Luchini
authors.affiliation: Department of Neurosciences, University of Padova, Padua, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Solmi
authors.affiliation: Department of Medicine, Geriatrics Section, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sergi
authors.affiliation: Department of Medicine, Geriatrics Section, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Manzato
authors.affiliation: Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.|Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK.|Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK.
authors.forename: Brendon
authors.initials: B
authors.lastname: Stubbs
mesh_terms: D000368:Aged; D015519:Bone Density; D001842:Bone and Bones / Q000473:pathology* / Q000503:physiopathology; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008998:Monoclonal Gammopathy of Undetermined Significance / Q000473:pathology* / Q000503:physiopathology; D016017:Odds Ratio; D015995:Prevalence
keywords: Aging; Fractures; Monoclonal gammopathy of undetermined significance; Osteoporosis