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Rögnvaldsson S, Aspelund T, Thorsteinsdóttir S, et al. Untangling fracture risk in monoclonal gammopathy of undetermined significance: A population-based cohort study. Eur J Haematol. 2021;107(1):137-144doi: 10.1111/ejh.13633.
Rögnvaldsson, S., Aspelund, T., Thorsteinsdóttir, S., Turesson, I., Björkholm, M., Landgren, O., & Kristinsson, S. Y. (2021). Untangling fracture risk in monoclonal gammopathy of undetermined significance: A population-based cohort study. European journal of haematology, 107(1), 137-144. https://doi.org/10.1111/ejh.13633
Rögnvaldsson, Saemundur, et al. "Untangling fracture risk in monoclonal gammopathy of undetermined significance: A population-based cohort study." European journal of haematology vol. 107,1 (2021): 137-144. doi: https://doi.org/10.1111/ejh.13633
Rögnvaldsson S, Aspelund T, Thorsteinsdóttir S, Turesson I, Björkholm M, Landgren O, Kristinsson SY. Untangling fracture risk in monoclonal gammopathy of undetermined significance: A population-based cohort study. Eur J Haematol. 2021 Jul;107(1):137-144. doi: 10.1111/ejh.13633. Epub 2021 Apr 28. PMID: 33840154.
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Eur J Haematol. 2021 Jul;107(1):137-144. doi: 10.1111/ejh.13633. Epub 2021 Apr 28.

Untangling fracture risk in monoclonal gammopathy of undetermined significance: A population-based cohort study.

European journal of haematology

Saemundur Rögnvaldsson, Thor Aspelund, Sigrún Thorsteinsdóttir, Ingemar Turesson, Magnus Björkholm, Ola Landgren, Sigurður Yngvi Kristinsson

Affiliations

  1. Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
  2. Department of Haematology, Rigshospitalet, Copenhagen, Denmark.
  3. Skåne University Hospital, Malmö/Lund, Sweden.
  4. Department of Medicine, Karolinska University Hospital Solna and Institutet, Stockholm, Sweden.
  5. Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.

PMID: 33840154 DOI: 10.1111/ejh.13633

Abstract

OBJECTIVE: Monoclonal gammopathy of undetermined significance (MGUS) is the asymptomatic precursor of multiple myeloma (MM). Lytic bone lesions and fractures are hallmarks of MM and although there are no lytic lesions in MGUS, it has also been associated with fractures. The causes of fractures in MGUS are currently unclear but potential causes include inherent MGUS bone disease, undiagnosed MM, and peripheral neuropathy (PN). We therefore conducted a large population-based study including 8395 individuals with MGUS and 30 851 matched controls from Sweden.

METHODS: Data on fractures, PN, and confounders were acquired from high-quality registers in Sweden.

RESULTS: Monoclonal gammopathy of undetermined significance and PN were independently associated with fractures (hazard ratio [HR]: 1.29; 95% confidence interval [95% CI]: 1.21-1.37; P < .001 and HR: 1.34; 95% CI: 1.16-1.55; P < .001). Imminent MGUS progression increased the risk of fractures (odds ratio: 1.66; 95% CI: 1.27-2.16; P < .001). Fractures were not associated with long-term risk of MGUS progression (HR: 1.08; 95% CI: 0.77-1.53; P = .64).

DISCUSSION: Based on these findings, we speculate that MGUS leads to fractures through at least 3 independent mechanisms: undetected MGUS progression to MM, MGUS inherent bone disease, and PN through falls. These findings highlight the need for further study of MGUS inherent bone disease and can inform further research into fracture prevention in MGUS.

© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Keywords: bone disease; fractures; monoclonal gammopathy of undetermined significance; multiple myeloma; neuropathy

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