Since the patients diagnosed with myelodysplastic syndrome are usually in the elderly group, osteopenia or osteoporosis is expected in these patients. However, there are no sufficient studies on osteoporosis or bone density in MDS patients. This may be due to the poor prognosis and aggressive course of some patients with MDS and the inadequate clinical conditions which may be considered as a side disease such as osteoporosis. Moreover, osteoporosis was not a remarkable disease in this patient group because of the fact that advanced age-related diseases were more prominent.

In this study, we aimed to examine MDS patients retrospectively, in terms of osteoporosis who were followed-up in Cerrahpasa Medical Faculty Internal Medicine Department, Department of Hematology. In only 11 of the 105 MDS patients which we had access to the data of bone health and bone disease were evaluated in the foreground due to complaints of bone pain and skeletal system.

In 11 patients included in this study, nine of them had decreased bone density at osteopenia or osteoporosis level. The 2 patients who had normal DXA examination were 69 and 72 years old. The vitamin D levels of these two patients were 14.9 ng/ml and 37.5 ng/ml, respectively. The patient with low vitamin D levels had a high risk compared to R-IPSS and had used 21 units of packed red blood cell transfusion with the diagnosis of MDS for 2.5 years. The patient benefited from azacitidin, which was initiated with the indication of RAEB-II. The patient with vitamin D> 30 ng / ml was refractory to azacitidine, the R-IPSS score was intermediate with thrombocytopenia requiring transfusion. No difference was observed in terms of age and follow-up times when the data compared of 9 patients with osteopenia or osteoporosis and the 2 patients DXA examination with normal bone density.

No statistical analysis was performed due to the small number of patients. The median values of R-IPSS were higher in 2 patients with normal bone density and the need for erythrocyte transfusion was higher in these patients. No statistically significant difference was found between patients with osteoporosis or osteopenia compared to patients with normal bone density in terms of transfusion requirement, vitamin D levels and R-IPSS scores. However, the low number of patients should be considered in this evaluation. When DXA values are investigated, whether bone density is correlated with transfusion, age, vitamin D levels, R-IPSS ; as expected, a statistically significant correlation was found between the presence of osteoporosis and DXA values, but only a significant linear correlation was found between R-IPSS and lumbar DXA values.

Since our study was not prospectively designed, we could not make an inference about the frequency of osteoporosis in MDS. For this purpose, prospective studies are needed comparing sex and age-matched groups with sufficient number of patients and controls. In our study, we obtained a borderline significant result, suggesting that lumbar bone density increased in patients with high R-IPSS only; however, it is difficult to assess the significance of this result due to the small number of patients. If evaluated indirectly, osteoporosis can be interpreted as seen in patients with low-risk MDS. Although this may be explained by the longer follow-up period due to the slower course of the disease in low-risk MDS patients, there was no difference in the follow-up period between the low and medium-risk groups in our study.

As a result, MDS provides a basis for osteoporosis due to the fact that it is an advanced age disease and it is indirectly related to bone health. Although few clinical study has given a clue about the association of MDS-osteoporosis, it is not possible to evaluate these studies reliable for many reasons such as heterogeneity of the disease, environmental factors and geographic variables. We hope that this retrospective study will still lead to greater prospective studies by awakening an awareness on this subject, in order to reach statistically significant results in future studies, it is important to homogenize patient groups in terms of prognostic class, age and gender.