Monoclonal Proteins in Elderly Patients with Osteoporosis
Notice bibliographique
Résumé
Abstract Background: Monoclonal proteins (M-proteins) and osteoporosis are both common in the elderly. For most patients with M-proteins and osteoporosis, the protein represents monoclonal gammopathy of undetermined significance (MGUS). In rare cases, the M-protein signifies multiple myeloma, and the osteoporosis is secondary to myeloma bone disease. Thus, it is important to identify M-proteins in patients presenting with osteoporosis, and to consider whether such patients could have myeloma. Objectives: To determine the prevalence of M-proteins in patients age 65 and older referred to the Osteoporosis Clinic at BC Womens’ Hospital in Vancouver, BC, to review the management of patients with M-proteins, and to determine if the characteristics of patients with M-proteins differ from those without M-proteins. Methods: A retrospective chart review of patients age 65 and older referred to the Osteoporosis Clinic at BC Women’s Hospital from April 2006 – March 2008 was performed. Patient demographics, CBC, creatinine, calcium, serum protein electrophoresis, bone marrow biopsy results if available, bone density, presence of osteolytic lesions, fractures, and clinical diagnoses were recorded. Results: 224 charts were reviewed from 205 female and 19 male patients. Osteoporosis was diagnosed in 202 patients. 16 patients (7.1%) had an M-protein. The concentration of the M-protein ranged from <1 g/L to 11 g/L. The characteristics of patients with and without M-proteins are presented in Table 1. Seven patients (3.1%) had background suppression of immunoglobulins with no detectable M-protein. Eight patients (50%) with M-protein had documented vertebral compression fractures compared to 70 patients (38%) with no M-protein. Five patients (31%) with and 41 patients (23%) without M-proteins had other fragility fractures. One patient with an M-protein had a mild anemia. All patients with M-proteins had normal calcium and creatinine. One patient with an M-protein was already known to have a B-cell lymphoma. Two patients were referred to a hematologist. One patient had a bone marrow biopsy and was diagnosed with multiple myeloma. No other patients were thought to have multiple myeloma, but no other bone marrow biopsies were performed. No extra investigations were done in the patients with hypogammaglobulinemia in the absence of an M-protein. Table 1. Characteristics of patients with and without M-proteins. Characteristic No M-Protein (n=201) M-Protein (n=16) Female (%) 184 (91) 14 (88) Age Mean ± SD 74 ± 7.7 77 ± 9.1 Osteoporosis (%) 182 (90) 15 (94) BD Mean ± SD −2.6 ± 1.2 −2.4 ± 1.5 Vertebral # (%) 70 (35) 8 (50) Fragility # (%) 41 (20) 5 (31) Conclusions: M-proteins are more common in elderly patients with osteoporosis than in the general population. Patients with osteoporosis and M-proteins may have an increased risk of fracture compared to such patients without M-proteins. In elderly patients with osteoporosis and M-proteins, it seems likely that the most common plasma cell dyscrasia is MGUS. However, the prevalence of multiple myeloma in these patients is unclear, and a standard approach to investigation is needed. While it is important not to miss a diagnosis of multiple myeloma, it is also prudent to avoid unnecessary invasive procedures (ie. bone marrow biopsies) in elderly and sometimes frail patients.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».