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Publications

Journal Article Ahead of print

PubMed: 42709184 DOI: 10.1007/s00198-026-08178-0

Clinical guidance on evaluation and management of bone fragility in patients with monoclonal gammopathy of undetermined significance (MGUS): an IOF position statement.

Osteoporos Int

Authors: Cyrille B Confavreux, Beatrice Bouvard, Robert Blank, Peyman Hadji, Emmanuel Biver, Jean-Jacques Body, Maria Luisa Brandi, Claudia Campusano, Peter R Ebeling, Abdellah El Maghraoui, Gerold Holzer, David Kendler, Tobie de Villiers, René Rizzoli, A Joseph Foldes

Affiliations

  • DĂ©partement de Rhumatologie Sud, Centre Expert Des MĂ©tastases Osseuses (CEMOS), Institut de CancĂ©rologie Des Hospices Civils de Lyon, HĂ´pital Lyon Sud, 165 Ch du Grand Revoyet, Pierre-BĂ©nite, 69495, France.
  • INSERM UMR1033 - LYOS, UniversitĂ© Claude Bernard Lyon 1, UniversitĂ© de Lyon, Lyon, 69100, France.
  • Centre de Recherche en CancĂ©rologie de Lyon (CRCL), UMR INSERM 1052 CNRS 5286, UniversitĂ© Claude Bernard Lyon 1, UniversitĂ© de Lyon, Lyon, 69100, France.
  • CHU Angers, Service de Rhumatologie, Angers, 49933, France.
  • INSERM, Regenerative Medicine and Skeleton, Univ Angers, Nantes UniversitĂ©, Oniris, RMeS, UMR 1229, Angers, 49000, France.
  • Garvan Institute of Medical Research, Sydney, Australia.
  • Medical College of Wisconsin, Milwaukee, USA.
  • Frankfurt Center of Bone Health and Endocrinology, Frankfurt, Germany.
  • Philipps-University of Marburg, Marburg, Germany.
  • Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
  • Department of Medicine, CHU Brugmann, UniversitĂ© Libre de Bruxelles, Brussels, Belgium.
  • FIRMO Foundation, Florence, Italy.
  • Department of Medicine, Clinica Universidad de los Andes, Universidad de los Andes, Santiago de Chile, Chile.
  • Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Melbourne, VIC, Australia.
  • Rheumatology Office, Mohamed V University, Rabat, Morocco.
  • Dept. of Orthopedics, Medical University of Vienna, Vienna, Austria.
  • Department of Medicine, University of British Columbia, Vancouver, Canada.
  • Department of Gynaecology, Medical Faculty, Stellenbosch University, Western Cape, Stellenbosch, South Africa.
  • Osteoporosis Center, Hadassah Mount-Scopus University Hospital, Jerusalem, Israel.

Abstract

UNLABELLED

Monoclonal gammopathy of undetermined significance (MGUS) is a frequent hematological condition that occurs in later life. MGUS is associated with increased fragility fractures that mix individual osteoporotic risk factors, MGUS-related comorbidities, and direct MGUS bone impact such as senescence of plasma cells. This International Osteoporosis Foundation (IOF) position statement aims at evaluating the potential relationship between MGUS and fracture risk, as well as methods for evaluating bone involvement in MGUS. Finally, we propose the first bone clinical guidance for patients with MGUS to improve their bone health.

BACKGROUND

Monoclonal gammopathy of undetermined significance is a prevalent hematological condition in adults, characterized by the presence of an abnormal monoclonal protein in the blood without concomitant symptoms or malignancy. MGUS is of considerable bone significance and contributes to fragility fractures in adults.

METHODS

In this review, data pertaining to bone fragility were collected, including epidemiological fracture data in patients with MGUS, bone mineral density (BMD), bone microarchitecture, bone turnover marker, and bone histomorphometry data.

RESULTS

Collectively, these findings suggest an elevated risk of fractures, especially in presence of osteoporotic risk factors or comorbidities, and a diminished BMD due to augmented bone resorption. Studies focusing on the treatment of this condition are limited.

CONCLUSION

Based on this analysis, we present the International Osteoporosis Foundation (IOF) position statement for bone evaluation and management of these patients. We recommend a risk-adapted treatment strategy. A proposal of bone clinical guidance dedicated to patients with MGUS is presented, suggesting bisphosphonates as the preferred treatment option.

MeSH

Comorbidity, Osteoporosis, Risk Factors, Therapeutics, Monoclonal Gammopathy Of Undetermined Significance