Zijlstra Hester, Te Velde Jens P, Striano Brendan M, Groot Olivier Q, de Groot Tom M, Raje Noopur, Patel Chirayu, Husseini Jad, Delawi Diyar, Kempen Diederik H R, Verlaan Jorrit-Jan, Schwab Joseph H
Department of Orthopedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Global Spine J. 2025 Apr;15(3):1712-1724. doi: 10.1177/21925682241260651. Epub 2024 Jun 10.
Study DesignRetrospective cohort study.ObjectiveIn general, Multiple Myeloma (MM) patients are treated with systemic therapy including chemotherapy. Radiation therapy can have an important supportive role in the palliative management of MM-related osteolytic lesions. Our study aims to investigate the degree of radiation-induced remineralization in MM patients to gain a better understanding of its potential impact on bone mineral density and, consequently, fracture prevention. Our primary outcome measure was percent change in bone mineral density measured in Hounsfield Units (Δ% HU) between pre- and post-radiation measurements, compared to non-targeted vertebrae.MethodsWe included 119 patients with MM who underwent radiotherapy of the spine between January 2010 and June 2021 and who had a CT scan of the spine at baseline and between 3-24 months after radiation. A linear mixed effect model tested any differences in remineralization rate per month (β) between targeted and non-targeted vertebrae.ResultsAnalyses of CT scans yielded 565 unique vertebrae (366 targeted and 199 non-targeted vertebrae). In both targeted and non-targeted vertebrae, there was an increase in bone density per month (β = .04; = .002) with the largest effect being between 9-18 months post-radiation. Radiation did not cause a greater increase in bone density per month compared to non-targeted vertebrae (β = .67; = .118).ConclusionOur results demonstrate that following radiation, bone density increased over time for both targeted and non-targeted vertebrae. However, no conclusive evidence was found that targeted vertebrae have a higher remineralization rate than non-targeted vertebrae in patients with MM.
研究设计
回顾性队列研究。
目的
一般而言，多发性骨髓瘤（MM）患者接受包括化疗在内的全身治疗。放射治疗在MM相关溶骨性病变的姑息治疗中可发挥重要的支持作用。我们的研究旨在调查MM患者中放射诱导的再矿化程度，以更好地了解其对骨密度的潜在影响，从而预防骨折。我们的主要结局指标是与非靶椎相比，放射前后以亨氏单位（Δ% HU）测量的骨密度变化百分比。
方法
我们纳入了119例在2010年1月至2021年6月期间接受脊柱放疗的MM患者，这些患者在基线时以及放疗后3 - 24个月进行了脊柱CT扫描。采用线性混合效应模型测试靶椎和非靶椎每月再矿化率（β）的差异。
结果
CT扫描分析得出565个独特的椎体（366个靶椎和199个非靶椎）。在靶椎和非靶椎中，每月骨密度均有增加（β = 0.04；P = 0.002），最大效应出现在放疗后9 - 18个月。与非靶椎相比，放射并未导致每月骨密度有更大增加（β = 0.67；P = 0.118）。
结论
我们的结果表明，放疗后，靶椎和非靶椎的骨密度均随时间增加。然而，未发现确凿证据表明MM患者中靶椎的再矿化率高于非靶椎。
