Study Finds Mortality Link Between Fractures, Multiple Myeloma

A recent study using data from the Women’s Health Initiative dataset discovered that a higher fracture risk was associated with higher mortality in multiple myeloma (MM) in postmenopausal women.

The study identified 362 women with MM of the161,808 enrolled in the WHI dataset. Fracture risk was evaluated by using the Fracture Risk Assessment Tool (FRAX), a computer-based algorithm that calculates the 10-year probability of a major fracture (hip, clinical spine, humerus, or wrist) and the 10-year probability of a hip fracture using select patient characteristics such as age, body mass index (BMI), and dichotomized clinical risk factors (eg, parental history of hip fracture, prior fragility fracture, current tobacco use).

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The study was undertaken to determine how concurrent osteoporosis is associated with poorer outcomes in patients who develop MM, a blood cancer of aging adults. Primary osteoporosis is also highly prevalent in aging adults and is associated with increased mortality.

Of the 362 participants who developed incident MM, with an average 10.5 years of follow-up, 226 died, including 71 with high FRAX scores and 155 with low FRAX scores.

On average, women with high FRAX scores were 8.3 years older at enrollment (95% confidence interval [CI], 7.2-9.3 years) and 8 years older at time of MM diagnosis (95% CI, 7.0-9.2 years) compared with those with low FRAX scores.

MM mortality for women with high FRAX scores was greater (covariate-adjusted hazard ratio scores [aHR] 1.51; 95% CI, 1.01-2.25; P = .044) compared with those with low FRAX scores.

In an interview with CURE, a sister brand of The American Journal of Managed Care^®, researcher Ashley Rosko, MD, an assistant professor at The Ohio State University Comprehensive Cancer Center, explained that a condition called monoclonal gammopathy of undetermined significance (MGUS) contributes to poor bone health development and predates nearly all patients diagnosed with MM.

For patients with both osteoporosis and MGUS, Rosko said it is “reasonable for them to see a hematologist just to make sure there isn't any underlying problems or developing problems over time.” Whether or not MGUS accelerates osteoporosis is not known and needs further research, she said.

Reference

Rosko AE, Hade E, Li W, et al. Bone health and survival in women with multiple myeloma. [published online June 7, 2018]. Clin Lymphoma Myeloma Leuk. doi:10.1016/j.clml.2018.06.002.