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Patients with systemic mastocytosis: calculate their fracture risk

Published: August 14, 2021

Systemic Mastocytosis (SM) is a condition where increased mast cell (MC) presence and MC mediator release affect various organs and organ systems, including the skeletal system. As a result, patients with SM often exhibit an increased degree of osteoporosis and fracture occurrence. Several studies primarily targeting a European cohort have studied fracture risk and reported criteria for assessment and treatment.

In a recent issue of The Journal of Clinical Immunology: In Practice, Makovoz et al assessed the fracture risk specifically among North American patients with SM. A retrospective analysis was performed on 50 patients to understand their fracture prevalence and determine risk factors. This analysis included patients’ basic demographic information, dual energy x-ray absorptiometry (DXA) scans for bone mineral density, trabecular bone scores (TBS) for bone microarchitecture, laboratory markers such as alkaline phosphatase (ALP), and detailed fracture history. The fracture history was obtained through careful surveying of each patient and every self-reported fracture incident.

This study identified 3 specific measurements that stood out as unique predictors of fracture risk for this North American cohort. Together, a patient’s age, ALP level, and DXA spine T-score were found to be strong predictors of an individual’s likelihood of having a fracture. These 3 predictors together had an accuracy of 81.25% as a fracture risk prediction model. As part of the study, a calculator was created to put this model to clinical use. This calculator is available online and accepts customized input of these three values to determine if an individual with SM is at increased risk for a fracture. Easy access and use of this calculator may significantly increase early detection of fracture risk for patients with SM which can direct management and treatment.

The Journal of Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for practicing clinicians.

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