Bone health in myelodysplastic neoplasms: results from the prospective longitudinal BoHemE study

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, longitudinal setting. Within the Bone and Hematology in Elderly (BoHemE) study, bone mineral density (represented as T-score) and bone-specific serum markers were assessed in patients 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 cohort [-0.7; p < 0.05], but the occurrence in controls had no effect. Albumin-adjusted calcium and phosphate levels correlated with T-scores within the MDS cohort [p < 0.0001 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 [-0.3; p < 0.05]. The presence of osteoporosis was associated with poor overall survival in MDS [p < 0.01]. In conclusion, bone health should be evaluated as part of the diagnostic work-up and clinical management of MDS.