识别非霍奇金淋巴瘤患者发生治疗相关性椎体密度丢失和骨折的风险。
Identification of non-Hodgkin lymphoma patients at risk for treatment-related vertebral density loss and fractures.
机构信息
Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, 185 Berry Street, Lobby 6, Suite 350, San Francisco, CA, 94158, USA.
Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
出版信息
Osteoporos Int. 2021 Feb;32(2):281-291. doi: 10.1007/s00198-020-05577-9. Epub 2020 Aug 15.
UNLABELLED
Information on bone loss in treated non-Hodgkin's lymphoma patients is limited. In this study, we used CT to analyze bone loss as well as prevalent and incident fractures. We found severe bone loss, a high rate of fractures, and a novel association between bone loss and the international prognostic index.
INTRODUCTION
To investigate bone loss and fracture risk in non-Hodgkin-lymphoma (NHL) patients by (i) comparing treatment-related vertebral density (VD) loss in NHL patients with control subjects and (ii) investigating associations of VD loss versus fracture risk. Further, associations of VD loss and clinical parameters were investigated.
METHODS
VD of 123 NHL patients was measured pre- and post-treatment in the L1, L2, and L3 vertebrae in routine computed tomography (CT) scans, performed between Jan 2016 and Mar 2017. Control measurements (n = 52) were obtained from CT colonographies between Sept 2003 and Sept 2017 and their subsequent follow-up-exams (10-137 months). Prevalent and incident (between baseline and follow-up) fractures were assessed in all subjects, and VD loss per year was calculated. Linear regression models were used to (i) compare VD loss between patients and controls and (ii) identify associations between VD loss and clinical parameters. Using logistic regression models, ORs for fractures per SD change in VD were assessed in patients. Analyses were adjusted for age, sex, and contrast application.
RESULTS
NHL patients experienced significantly greater VD loss than controls (P = 0.003), and greater VD loss was associated with a greater likelihood of incident fractures (OR, [95%-CI], P 1.90, [1.03, 3.51], 0.04). Patients with an initial international prognostic index (IPI) of 5 suffered significantly greater VD loss compared with an IPI of 0 (P = 0.01).
CONCLUSION
Using VD measurements in routine CT scans, substantial vertebral bone loss in NHL patients could be documented with a high incidence of fractures.
目的
通过(i)比较非霍奇金淋巴瘤（NHL）患者与对照者治疗相关的椎体密度（VD）丢失，以及（ii）研究 VD 丢失与骨折风险之间的关系，来调查 NHL 患者的骨丢失和骨折风险。此外，还研究了 VD 丢失与临床参数之间的关系。
方法
2016 年 1 月至 2017 年 3 月期间，在常规计算机断层扫描（CT）中测量了 123 例 NHL 患者治疗前后 L1、L2 和 L3 椎体的 VD。对照测量（n=52）是从 2003 年 9 月至 2017 年 9 月期间的 CT 结肠成像及其随后的随访检查（10-137 个月）中获得的。在所有受试者中评估了现患和（基线和随访期间）新发骨折，计算了每年的 VD 丢失量。使用线性回归模型（i）比较患者和对照组之间的 VD 丢失量，（ii）确定 VD 丢失与临床参数之间的关系。在患者中，使用逻辑回归模型评估了 VD 每标准差变化与骨折的比值比（OR）。分析调整了年龄、性别和对比剂应用。
结果
NHL 患者的 VD 丢失量明显大于对照组（P=0.003），且 VD 丢失量越大，新发骨折的可能性越大（OR，[95%CI]，P=0.04）。与初始国际预后指数（IPI）为 0 相比，初始 IPI 为 5 的患者 VD 丢失量明显更大（P=0.01）。
结论
使用常规 CT 扫描中的 VD 测量值，可记录 NHL 患者的椎体骨量大量丢失，且骨折发生率较高。
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