Identification of non-Hodgkin lymphoma patients at risk for treatment-related vertebral density loss and fractures

Bodden, J.; Sun, D.; Joseph, G. B.; Huang, L.-W.; Andreadis, C.; Hughes-Fulford, M.; Lang, T. F.; Link, T. M.

Affiliations

¹Musculoskeletal 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

²Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany

³Department of Hematology and Oncology, University of California San Francisco, 400 Parnassus Ave, San Francisco, CA 94143, USA

⁴Department of Biochemistry and Biophysics, University of California San Francisco, 600 16th St, San Francisco, CA 94158, USA

Abstract and keywords

Summary: 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 VDL1–3 loss than controls (P = 0.003), and greater VDL1–3 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.

Keywords: Bone density; Computed tomography; Non-Hodgkin lymphoma; Osteoporosis; Screening

Links

DOI: 10.1007/s00198-020-05577-9

PubMed: 32803319

WoS: 000559950000005

History

Received: 2020-04-30

Accepted: 2020-07-29

Online: 2020-08-15

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