Prospective study of bone health in myelodysplastic neoplasms

Myelodysplastic neoplasms (MDS) are characterized by insufficient hematopoiesis and alterations of the bone marrow microenvironment. However, bone health in MDS has not been evaluated in a prospective setting. In the prospective BoHemE study (‘bone and hematology in elderly’), at the University Hospital Dresden and the University Hospital Leipzig (both in Germany), bone mineral density (represented as T-score) and bone-specific serum markers were assessed in patients older than 60 years with MDS (n=111; 36% female) and age-matched controls (n=84; 55% female) at baseline and after 3 years. At baseline, patients with MDS had a lower T-score (-0.2; p<0.05) compared to controls, which was mainly attributed to the lower T-score in women with MDS (-0.3; p<0.05). Furthermore, the DNMT3A mutation was associated with a lower T-score within the MDS group (-0.7; p<0.05) but not in the control group. Albumin-adjusted calcium and phosphate levels correlated with T-scores within the MDS group (p<0.001 and p<0.01, respectively) independent of age, sex, MDS duration, IPSS-M score, or transfusion dependence. Quality of life was lower in patients with MDS (p<0.01) and remained stable over 3 years, whereas T-scores declined. The presence of osteoporosis was associated with poor overall survival in MDS (p<0.01). The authors conclude that bone health should be evaluated as part of the diagnostic work-up and clinical management of MDS.