Fractures in Patients With MM Negatively Impact Survival, Study Says

Due to the nature of the disease, multiple myeloma (MM) causes lytic bone lesions and fractures, but the impact of fractures on survival is unknown. A recent study indicates that patients with MM and fractures are at a significantly increased risk of death compared with patients who do not have fractures.

Patients with MM and bone disease have a reduced quality of life, as the interaction between malignant plasma cells in the bone marrow and the bone microenvironment leads to the destruction of bone and reduced osteoblast function, as well as blocking of bone repair. Fractures may be caused by decreased bone mineral density and treatment with glucocorticoids; in a previous population-based retrospective study, patients had a 9-fold increase in the risk of factors after MM diagnosis.

Using the Swedish Cancer Registry, researchers obtained data from patients with MM diagnosed between 1990 to 2013. Using a Cox regression model, researchers compared survival in patients with and without a fracture at MM diagnosis. Another Cox model was used with fracture as a time-dependent variable to assess the effect of fracture on survival after diagnosis.

A total of 14,013 patients were diagnosed during the study; 1213 (8.7%) were diagnosed with a fracture at the time of MM diagnosis, and 3235 (23.1%) after diagnosis.

The adjusted results showed that patients with a fracture at diagnosis were at a significantly increased risk of death (hazard ratio [HR], 1.28; 95% CI, 1.19-1.37). The risk of death was significantly increased in patients with a fracture after MM diagnosis (HR, 2.00; 95% CI, 1.90-2.10).

The impact of fractures on survival did not change significantly between the 2 calendar periods—1990-1999 and 2000-2013—in the study (HR, 0.98; 95% CI, 0.89-1.08).

The authors said that patients with MM with fractures are at a significantly increased risk of dying compared with those without fractures. The findings show the importance of preventing bone disease in multiple myeloma, they said

Reference

Thorsteinsdottir S, Gislason G, Aspelund T, et al. Fractures and survival in multiple myeloma: results from a population-based study [published online December 2, 2019]. Haematol. doi:10.3324/haematol.2019.230011.