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Dr. Thomas, MD
Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 63757
Experience:  Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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I have MGUS (monoclonal gamography of unspecified

Customer Question

I have MGUS (monoclonal gamography of unspecified significance) and I fell and broke my Rt humerus 9 months ago. It has not healed. Would MGUS cause slow or non healing? What affect does MGUS have on bone healing?
Submitted: 8 months ago.
Category: Medical
Expert:  khagihara replied 8 months ago.

It is possible that the slow healing is due to MGUS. You should have a dual energy x-ray absorptiometry (DEXA) scan and have vitamin D, calcium, and bisphosphonates.

Patients with MGUS have an increased risk of axial (skull, vertebral/pelvis, and sternum/costae), but not peripheral (arm and leg), bone fractures, with the highest risk being noted in those with reduced lumbar bone mineral density. The pathophysiologic basis for this finding is unclear, although both an imbalance between bone resorption and bone formation and altered bone microstructure have been postulated.

Patients with MGUS had an increased risk of fracture at five years and 10 years. This increased risk was greatest for axial fractures.

Patients with MGUS should be evaluated for osteoporosis and osteopenia with a dual energy x-ray absorptiometry (DEXA) scan and have their vitamin D and calcium intake optimized . Bisphosphonates should be used in these patients only if they have another indication for their use, such as osteoporosis or osteopenia on bone mineral density studies.

Expert:  Dr. Thomas, MD replied 8 months ago.

Hello

I am a double board certified US doctor.

In fact, there is an increased risk for arm fractures.

It is simply that axial fractures are further increased.

In fact, for peripheral fractures, arm is significantly increased.

The disruption in bone dynamics is clear.

the benefit of biphosphenates is not entirely clear.

IN any case, this was based on a larger study.

Studies that are two small don't show the increased risk of distal fractures.

However, it is there.

See this link

http://www.bloodjournal.org/content/116/15/2651?sso-checked=true

In addition, based on longer term follow up, patients with MUGUS are at increased risk for ANY type of fracture

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3324256/

Your question is really how to get this fracture to heal.

That management is not entirely clear from the research.

I am a double board certified US doctor.

Find me , Dr. Thomas as needed.

Please click a positive rating.