Veronese Nicola, Luchini Claudio, Solmi Marco, Sergi Giuseppe, Manzato Enzo, Stubbs Brendon
Department of Medicine, Geriatrics Section, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy.
J Bone Miner Metab. 2018 Jan;36(1):128-132. doi: 10.1007/s00774-017-0817-8. Epub 2017 Feb 27.
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, I = 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.
意义未明的单克隆丙种球蛋白病（MGUS）在老年人中较为常见。许多研究探讨了MGUS与包括骨密度（BMD）、骨质疏松症和骨折在内的骨骼健康结局之间的关系，但尚无荟萃分析。我们进行了一项系统评价和探索性荟萃分析，比较MGUS患者的骨骼健康结局。两位独立作者检索了自数据库建立至2016年10月19日的PubMed和Scopus数据库。对调查骨折和BMD的横断面及纵向研究进行了荟萃分析。计算BMD的标准化均数差（SMD）±95%置信区间（CI），计算现患骨折和新发骨折的风险比（RR）。在174条初始检索结果中，10项方法学质量中等的研究符合要求，包括8711例MGUS患者和52865例对照。与对照组相比，MGUS患者的桡骨皮质体积骨密度值显著较低（1项研究；SMD = -5.45，95% CI：-7.24至-3.66），但在腰椎、股骨颈或髋部并非如此。在中位12.5年的随访中，MGUS患者（n = 7466）的骨折发生率高于对照组（n = 52304）（RR = 1.36，95% CI 1.28 - 1.44，I² = 0%）。椎体骨折的发生率尤其升高（RR = 2.50，95% CI 1.53 - 4.06），尽管仅限于两项研究。总之，尽管存在局限性，但我们的初步荟萃分析表明，尽管BMD差异的证据不明确，但MGUS患者骨折风险较高。未来需要进行纵向研究以证实我们的发现，并确定MGUS患者是否需要进行骨折预防干预。
