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Petty L, Stephens D, Sharma A. Risk Factors for Fragility Fractures in Chronic Lymphocytic Leukemia. Cureus 2024; 16:e54774. [PMID: 38523984 PMCID: PMC10961164 DOI: 10.7759/cureus.54774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Abnormal bone health and fragility fractures (FF) are more common in patients with chronic lymphocytic leukemia (CLL). We hypothesize that there may be risk factors in CLL patients with osteoporosis that increase the risk of FFs. We conducted a cohort study encompassing all patients diagnosed with CLL from January 1, 2000, to July 31, 2020, utilizing International Classification of Diseases (ICD) codes related to abnormal bone health (osteopenia, osteoporosis, and/or presence of FF) within a single tertiary care institution. Of the 89 patients included, 55 (62%) were female with a mean age of 68 ± 11 years at cohort entry. Fifty-nine (66%) had at least one FF present (pFF) and 30 (34%) did not have an FF (nFF). There were no differences in IGHV (Immunoglobulin heavy chain variable region gene) mutation status, chromosomal abnormalities, or the presence of a complex karyotype. The spine accounted for 81% of identified FF. T-score <-2.5 was more common in those without FF (pFF 38% vs. nFF 71%, P = 0.02). DXA evaluation was not conducted for 36 (40%) individuals within the cohort. Risk factors for fragility fractures included male sex (relative risk [RR] 8.1, 95% confidence interval [CI] 2.1-31.7), diabetes mellitus (RR 1.4, 95% CI 1.04-1.8), smoking (RR 1.3, 95% CI 1.02-1.8), Rai stage >0 (RR 1.4, 95% CI 1.04-1.9), and T-score >-2.5 (RR 1.8, 95% CI 1.1-3.1). There is a high frequency of vertebral FFs in people with CLL despite T-scores not being in the osteoporotic range. Increased awareness to screen and treat vertebral FFs in people with CLL is needed.
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Affiliation(s)
- Lloyd Petty
- Endocrinology, Diabetes, and Metabolism, University of Utah School of Medicine, Salt Lake City, USA
| | - Deborah Stephens
- Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, USA
| | - Anu Sharma
- Endocrinology, Diabetes, and Metabolism, University of Florida, Gainesville, USA
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Kraiger M, Klein-Rodewald T, Rathkolb B, Calzada-Wack J, Sanz-Moreno A, Fuchs H, Wolf E, Gailus-Durner V, de Angelis MH. Monitoring longitudinal disease progression in a novel murine Kit tumor model using high-field MRI. Sci Rep 2022; 12:14608. [PMID: 36028522 PMCID: PMC9418174 DOI: 10.1038/s41598-022-17880-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/02/2022] [Indexed: 11/09/2022] Open
Abstract
Animal models are an indispensable platform used in various research disciplines, enabling, for example, studies of basic biological mechanisms, pathological processes and new therapeutic interventions. In this study, we applied magnetic resonance imaging (MRI) to characterize the clinical picture of a novel N-ethyl-N-nitrosourea-induced Kit-mutant mouse in vivo. Seven C3H KitN824K/WT mutant animals each of both sexes and their littermates were monitored every other month for a period of twelve months. MRI relaxometry data of hematopoietic bone marrow and splenic tissue as well as high-resolution images of the gastrointestinal organs were acquired. Compared with controls, the mutants showed a dynamic change in the shape and volume of the cecum and enlarged Peyer´s patches were identified throughout the entire study. Mammary tumors were observed in the majority of mutant females and were first detected at eight months of age. Using relaxation measurements, a substantial decrease in longitudinal relaxation times in hematopoietic tissue was detected in mutants at one year of age. In contrast, transverse relaxation time of splenic tissue showed no differences between genotypes, except in two mutant mice, one of which had leukemia and the other hemangioma. In this study, in vivo MRI was used for the first time to thoroughly characterize the evolution of systemic manifestations of a novel Kit-induced tumor model and to document the observable organ-specific disease cascade.
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Affiliation(s)
- Markus Kraiger
- Institute of Experimental Genetics, German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
| | - Tanja Klein-Rodewald
- Institute of Experimental Genetics, German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Birgit Rathkolb
- Institute of Experimental Genetics, German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Institute of Molecular Animal Breeding and Biotechnology, Gene Center, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Julia Calzada-Wack
- Institute of Experimental Genetics, German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Adrián Sanz-Moreno
- Institute of Experimental Genetics, German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Helmut Fuchs
- Institute of Experimental Genetics, German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Eckhard Wolf
- Institute of Molecular Animal Breeding and Biotechnology, Gene Center, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Valérie Gailus-Durner
- Institute of Experimental Genetics, German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Martin Hrabě de Angelis
- Institute of Experimental Genetics, German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Chair of Experimental Genetics, TUM School of Life Sciences, Technische Universität München, Freising, Germany
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Baur-Melnyk A, Reiser M. Oncohaematologic disorders affecting the skeleton in the elderly. Radiol Clin North Am 2008; 46:785-98, vii. [PMID: 18922293 DOI: 10.1016/j.rcl.2008.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Multiple myeloma is a hemato-oncologic disease in the elderly population, with a peak incidence in the eighth decade, and represents a malignant bone marrow neoplasia in which a monoclonal strain of atypical plasma cells proliferates and may result in bone destruction. Skeletal metastases represent the most common malignant bone tumor and are the third most common location for distant metastases. They occur predominantly in adults, especially in the elderly population. Chronic lymphatic leukemia is a typical malignancy of the elderly patient and aplastic anemia is a hematologic disorder characterized by pancytopenia, bone marrow hypoplasia, and lack of extramedullary hematopoiesis. Osteomyelofibrosis and sclerosis are chronic myeloproliferative diseases of the elderly, with a peak incidence in the sixth and seventh decade of life. This article addresses these oncohaematologic disorders affecting the skeleton in the elderly, examining the radiographic scanning methods, staging, and prognosis for each.
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Affiliation(s)
- Andrea Baur-Melnyk
- Department of Clinical Radiology, University of Munich, Grosshadern, Germany.
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Hwang S, Panicek DM. Magnetic resonance imaging of bone marrow in oncology, Part 2. Skeletal Radiol 2007; 36:1017-27. [PMID: 17492444 DOI: 10.1007/s00256-007-0308-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 03/05/2007] [Accepted: 03/07/2007] [Indexed: 02/02/2023]
Abstract
Magnetic resonance imaging plays an integral role in the detection and characterization of marrow lesions, planning for biopsy or surgery, and post-treatment follow-up. To evaluate findings in bone marrow on MR imaging, it is essential to understand the normal composition and distribution of bone marrow and the changes in marrow that occur with age, as well as the basis for the MR signals from marrow and the factors that affect those signals; these points have been reviewed and illustrated in part 1 of this two-part article. Part 2 will emphasize the practical application of MR imaging to facilitate differentiation of normal marrow, tumor, and treatment-related marrow changes in oncology patients, and will review complementary MR techniques under development.
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Affiliation(s)
- Sinchun Hwang
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY 10021, USA
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Tall MA, Thompson AK, Vertinsky T, Palka PS. MR imaging of the spinal bone marrow. Magn Reson Imaging Clin N Am 2007; 15:175-98, vi. [PMID: 17599639 DOI: 10.1016/j.mric.2007.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Adequate interpretation of a cervical, thoracic, or lumbar spine MR imaging examination includes a careful evaluation of the bone marrow. Detecting an abnormality in bone marrow may cause a diagnostic dilemma because the marrow in the spine can vary in appearance according to the patient's age, and can be affected by infectious, inflammatory, metabolic, and neoplastic processes. Its appearance can be affected as well by underlying degenerative disc disease, trauma, and numerous iatrogenic therapies, including vertebroplasty, radiation therapy, and medications. In addition to conventional MR imaging sequences, newer imaging techniques, such as diffusion weighting and opposedphase sequences, are being studied to help increase the diagnostic accuracy of spine and bone marrow evaluation and to help differentiate benign from malignant and infectious processes.
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Affiliation(s)
- Michael A Tall
- Department of Radiology, David Grant Medical Center, 101 Bodin Circle, Travis Air Force Base, CA 94535, USA.
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Steinbach LS. "MRI in the detection of malignant infiltration of bone marrow"--a commentary. AJR Am J Roentgenol 2007; 188:1443-5. [PMID: 17515361 DOI: 10.2214/ajr.06.1531] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Lynne S Steinbach
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Suite M392, San Francisco, CA 94143-0628, USA.
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Alyas F, Saifuddin A, Connell D. MR Imaging Evaluation of the Bone Marrow and Marrow Infiltrative Disorders of the Lumbar Spine. Magn Reson Imaging Clin N Am 2007; 15:199-219, vi. [PMID: 17599640 DOI: 10.1016/j.mric.2007.03.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of MR imaging in assessing lumbar bone marrow first requires an understanding of the bone marrow's normal composition and the various imaging sequences available for use. One of the most useful sequences is the T1-weighted spin-echo sequence. This sequence may be combined with other sequences such as T2-weighted or diffusion-weighted sequences; techniques such as fat suppression, chemical shift imaging, and contrast-enhanced imaging are discussed. The varying features of normal lumbar marrow related to the normal physiologic changes that occur with aging and with changes in hematopoietic demand are important to understand and are described. The appearances of infiltrative marrow disease are explained on the basis of marrow composition and whether disease causes proliferation, replacement, or depletion of normal marrow components.
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Affiliation(s)
- Faisal Alyas
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London, UK, HA7 4LP
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Nöbauer I, Uffmann M. Differential diagnosis of focal and diffuse neoplastic diseases of bone marrow in MRI. Eur J Radiol 2005; 55:2-32. [PMID: 15950098 DOI: 10.1016/j.ejrad.2005.01.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2005] [Revised: 01/20/2005] [Accepted: 01/26/2005] [Indexed: 11/18/2022]
Abstract
Magnetic resonance imaging (MRI) has become the preferred imaging modality for the evaluation of malignant disease in the bone marrow. Compared to bone marrow aspiration and biopsy, MRI is noninvasive and provides information by sampling a large volume of bone marrow. Due to disease-related alterations in the composition of bone marrow, MRI provides a very high sensitivity, but lacks specificity for most bone marrow disorders. However, MRI can be a very valuable diagnostic tool properly placed within the clinical context.
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Affiliation(s)
- Iris Nöbauer
- Allgemeines Krankenhaus Wien, Medizinuniversität Wien, Universitätsklinik für Radiodiagnostik, Währinger Gürtel 18-20, A-1090 Wien, Austria.
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Stäbler A, Doma AB, Baur A, Krüger A, Reiser MF. Reactive bone marrow changes in infectious spondylitis: quantitative assessment with MR imaging. Radiology 2000; 217:863-8. [PMID: 11110955 DOI: 10.1148/radiology.217.3.r00dc23863] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate diffuse, reactive bone marrow changes in unaffected vertebrae on magnetic resonance (MR) images in patients with proved infectious spondylitis. MATERIALS AND METHODS Percentage signal intensity increase of the unaffected bone marrow on contrast material-enhanced MR images (percentage enhancement) was calculated retrospectively in 22 cases of infectious spondylitis and 86 cases without bone marrow disease. Multiple regression analysis and Student t test statistics were performed. RESULTS Multiple regression analysis showed a significant influence of age and the presence of spondylitis on the values of percentage enhancement (P: <.001). For those aged 35 years or younger, the mean percentage enhancement was 43.2% +/- 4.0 for patients with infectious spondylitis (n = 3) and was 26.4% +/- 8.6 for the control group (n = 23). For those older than 35 years, the mean percentage enhancement was 28.2% +/- 12.2 for patients with infectious spondylitis (n = 19) and 17.5% +/- 7.9 (P: <.001) for the control group (n = 63). Six (27%) of 22 patients with infectious spondylitis showed abnormal percentage enhancement values in unaffected bone marrow when the upper limit of the normal value was 2 SDs above the mean of the control group. CONCLUSION On MR images, reactive bone marrow changes can be found in unaffected vertebrae in patients with infectious spondylitis. The signal intensity changes and increased percentage enhancement associated with this disease are similar to those of myeloproliferative and diffuse neoplastic disorders and bone marrow stimulation in hemolytic anemia.
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Affiliation(s)
- A Stäbler
- Department of Clinical Radiology, University of Munich, Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany.
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Ballon D, Dyke J, Schwartz LH, Lis E, Schneider E, Lauto A, Jakubowski AA. Bone marrow segmentation in leukemia using diffusion and T (2) weighted echo planar magnetic resonance imaging. NMR IN BIOMEDICINE 2000; 13:321-328. [PMID: 11002312 DOI: 10.1002/1099-1492(200010)13:6<321::aid-nbm651>3.0.co;2-p] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Magnetic resonance images of leukemic bone marrow were acquired over large regions of the pelvis and lower abdomen with minimal interference from overlying tissues using diffusion and T(2) weighted echo planar imaging. Data acquisition times were on the order of 1 min for scanning volumes of up to 25 l at a spatial resolution of 31 microl. A survey of 21 patients with leukemia and eight healthy adult volunteers was undertaken to determine the magnitude of the observed effect and its dependence upon specific pathologies. The acquisition methods yielded high-quality segmentation of leukemic bone marrow prior to therapy in seven of seven patients with acute lymphocytic leukemia, chronic lymphocytic leukemia or chronic myelogenous leukemia, and who had hypercellular (>95%) bone marrow at the time of the study. The quality of the segmentation was sufficient to allow the use of maximum intensity projection images which afforded a convenient evaluation of both intra- and extramedullary disease. The measured signal-to-noise ratios agreed with a theoretical estimate that accounted for the percentage cellularity, T(2) relaxation time of water, and self-diffusion coefficient of water in iliac bone marrow. In addition, the mean signal-to-noise ratios from iliac marrow were strongly dependent upon the time after the initiation of chemotherapeutic regimens, implying that the methods may be useful for therapeutic monitoring.
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Affiliation(s)
- D Ballon
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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