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Abstract：
Multiple myeloma (MM) frequently causes vertebral fractures (VF). Some are lytic lesions and others have the aspect of benign osteoporotic fractures not requiring anti-myeloma treatment. We explored outcome of these patients with smoldering myeloma (SM) and osteoporotic VF. In this retrospective bi-centric study, patients were identified using a systematic keyword search on electronic medical records. Patients with SM and isolated VF of osteoporotic aspect without indications for myeloma-specific therapy were included. Overall, 13 (7 %) of the 184 identified patients had SM and VF confirmed to be osteoporotic (median number of VF was 3). During follow-up, 12 (92 %) patients evolved to symptomatic MM, 7 (54 %) of them within 18 months (early progressors). Myeloma defining events were new lytic bone lesions in 7 patients (53.8 %). The serum calcium level was significantly higher in the early progressor group (median 2.35 IQR [2.31-2.38] and 2.28 IQR [2.21-2.29] respectively, p = 0.003). Early progressors had a higher number of VF at diagnosis (3.0 [2.0-5.5] vs 1.0 [1.0-2.5], p = 0.18) and more frequently evolved to symptomatic MM because of lytic bone lesions (5 [71 %] vs 2 [33 %], p = 0.13) compared to late progressors. VF of osteoporotic appearance in the context of SM is a rare situation but at high risk of rapid progression to symptomatic MM, suggesting that they may represent bone fragility linked to MM infiltration rather than solely osteoporotic fractures. Further studies are needed to assess if earlier treatment might be beneficial in this population.
摘要：
多发性骨髓瘤（MM）经常导致椎骨骨折（VF）。有些是溶解性病变，有些则是良性骨质疏松性骨折，不需要抗骨髓瘤治疗。我们探讨了这些闷烧性骨髓瘤（SM）和骨质疏松性VF患者的预后。在这项回顾性的双中心研究中，通过对电子病历进行系统的关键词搜索来识别患者.包括患有SM和孤立的骨质疏松性VF而没有骨髓瘤特异性治疗指征的患者。总的来说,184名确定的患者中有13名（7％）患有SM和VF，证实为骨质疏松（VF的中位数为3）。随访期间,12例（92%）患者演变为有症状的MM，其中7人（54％）在18个月内（早期进展者）。骨髓瘤定义事件为7例患者（53.8％）的新溶骨病变。早期进展组的血清钙水平显着升高（中位数分别为2.35IQR[2.31-2.38]和2.28IQR[2.21-2.29]，p=0.003)。早期进展者在诊断时的VF数量较高（3.0[2.0-5.5]vs1.0[1.0-2.5]，p=0.18），并且由于溶解性骨病变而更频繁地发展为有症状的MM（5[71％]vs2[33％]，p=0.13）与晚期进展者相比。在SM的背景下，骨质疏松外观的VF是一种罕见的情况，但在快速进展为有症状的MM的高风险，提示它们可能代表与MM浸润相关的骨脆性，而不仅仅是骨质疏松性骨折。需要进一步的研究来评估早期治疗是否对该人群有益。
