BMJ  2005;330:818 (9 April), doi:10.1136/bmj.38376.401701.8F (published 14 March 2005)

Paper

Utility of testing for monoclonal bands in serum of patients with suspected osteoporosis: retrospective, cross sectional study

¹ Department of Endocrinology, Odense University Hospital, DK-5000 Odense C, Denmark, ² Department of Haematology, Odense University Hospital, ³ Department of Clinical Biochemistry, Odense University Hospital

Objective To determine whether measuring monoclonal bands (M component) in serum should be part of the investigation of patients referred to osteoporosis clinics.

Design Retrospective, cross sectional, observational study.

Setting Referral centre for osteoporosis in a university hospital, Denmark.

Participants 799 people (685 women) aged 19 to 94 years newly referred with suspected osteoporosis.

Main outcome measures Proportion of patients fulfilling the Nordic Myeloma Study Group definition for target condition and proportion of patients with other important haematological conditions.

Results 4.9% (18 of 366) of patients with osteoporosis and 2.2% (9 of 408) of patients without osteoporosis had M component in serum (² = 3.66, P = 0.04). Multiple myeloma was diagnosed in three patients with osteoporosis (absolute risk 0.8%, 95% confidence interval 0.11% to 1.7%). The relative risk of multiple myeloma in patients presenting with osteoporosis was 75 (10 to 160). As a diagnostic test for multiple myeloma in patients with osteoporosis, M component in serum had a specificity of 95.0% and a positive predictive value of 17.6%. 122 blood electrophoreses were carried out for each case of multiple myeloma diagnosed. All patients with multiple myeloma had a history of fragility fractures. If lymphoma was included as a target condition, the specificity increased to 95.3% and the positive predictive value increased to 23.5%. Monoclonal gammopathy of undetermined significance was diagnosed in 13 (3.6%) participants with osteoporosis and in eight (2.0%) participants with normal bone mineral density or osteopenia.

Conclusions Patients presenting with osteoporosis should be tested for M component in serum, as 1 in 20 patients with newly diagnosed osteoporosis had multiple myeloma or monoclonal gammopathy of undetermined significance.

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Test for M component in patients suspected of having osteoporosis
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• Kariyawasan, C.C., Hughes, D.A., Jayatillake, M.M., Mehta, A.B. (2007). Multiple myeloma: causes and consequences of delay in diagnosis. QJM 100: 635-640 [Abstract] [Full text]  

Rapid Responses:

Read all Rapid Responses

Oncological Terrain: “Conditio sine qua non” of Measuring monoclonal Bands in Patients with Osteoporosis.

Sergio Stagnaro
bmj.com, 8 Apr 2005 [Full text]

Risk for unnecessary intervention

Piero Baglioni
bmj.com, 10 Apr 2005 [Full text]

Re: Risk for unnecessary intervention

Bo Abrahamsen
bmj.com, 11 Apr 2005 [Full text]

Routine laboratory tests might be more cost - effective

Venkata Sreekanth Sampath
bmj.com, 12 Apr 2005 [Full text]

Re: Routine laboratory tests might be more cost - effective

Bo Abrahamsen
bmj.com, 13 Apr 2005 [Full text]

Re: Re: Routine laboratory tests might be more effective

Venkata Sreekanth Sampath
bmj.com, 13 Apr 2005 [Full text]

Re: Routine laboratory tests might be more effective

Bo Abrahamsen
bmj.com, 14 Apr 2005 [Full text]

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