Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Br J Haematol. 2017 Oct;179(1):61-65. doi: 10.1111/bjh.14815. Epub 2017 Jun 27.
Pathological fractures are a common complication of plasma cell dyscrasias (PCD) and are associated with significant morbidity. Routine use of bisphosphonates over the past decade has aimed to reduce the risk of fractures in patients with multiple myeloma, but despite this, fractures continue to represent a significant burden of disease. In this study we report the fracture rate of hospital in-patients with PCD in England. Data from the national registry Hospital Episode Statistics between 2001 and 2015 were used to determine fracture rate and its effect on overall survival. Fracture rates were 17·8 times higher than the general population in the first year after admission with PCD, and remained elevated for up to 10 years after first admission. The increased fracture risk preceded the first admission with PCD and, conversely, the incidence of PCD increased after admission with one or more fractures. Overall survival is improving with PCD, however poorer survival is found in patients with a preceding fracture (Hazard ratio 1·20). Despite widespread bisphosphonate use, fractures remain common in PCD, and are associated with poorer outcomes.
病理性骨折是浆细胞异常（PCD）的常见并发症，与显著的发病率相关。过去十年中，双膦酸盐的常规使用旨在降低多发性骨髓瘤患者发生骨折的风险，但尽管如此，骨折仍然是疾病的一个重要负担。在这项研究中，我们报告了英格兰 PCD 住院患者的骨折发生率。使用国家登记处医院入院统计数据（2001 年至 2015 年）来确定骨折发生率及其对总体生存的影响。在 PCD 入院后的第一年，骨折发生率比一般人群高 17.8 倍，并且在首次入院后长达 10 年内仍然升高。骨折风险的增加先于 PCD 的首次入院，相反，在一次或多次骨折入院后，PCD 的发病率增加。尽管 PCD 的总体生存率在提高，但骨折患者的生存率较差（风险比 1.20）。尽管广泛使用双膦酸盐，但 PCD 患者仍经常发生骨折，并且与较差的预后相关。
