Fractures and survival in multiple myeloma: results from a population-based study
Sigrun Thorsteinsdottir1,2, Gauti Gislason2, Thor Aspelund3
1Department of Internal Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland sth314@hi.is.
Abstract:
Multiple myeloma causes lytic bone lesions and fractures. The impact of fractures on multiple myeloma (MM) survival is unclear. The aim of this study was to evaluate the effect of fractures on survival in MM using data from MM patients diagnosed in Sweden in the years 1990-2013, identified from the Swedish Cancer Registry. Information on date of birth, MM diagnosis, fractures, and death was collected from central registries. A Cox regression model was used to compare survival in patients with and without a fracture at MM diagnosis and another Cox model was used with fracture as a time-dependent variable to assess the effect of fracture on survival after MM diagnosis. Results were adjusted for age, sex, year of diagnosis, and previous fractures. A total of 14,013 patients were diagnosed with MM during the study, of whom 1,213 (8.7%) were diagnosed with a fracture at MM diagnosis, and 3,235 (23.1%) after diagnosis. Patients with a fracture at diagnosis were at a significantly increased risk of death (hazard ratio=1.28; 95% confidence interval: 1.19-1.37). The risk of death was significantly increased in patients with a fracture after MM diagnosis (2.00; 1.90-2.10). The impact of fractures on survival did not change significantly between the two calendar periods 1990-1999 and 2000-2013 (0.98; 0.89-1.08). Our large study shows that MM patients with fractures are at a significantly increased risk of dying compared to those without fractures, which stresses the importance of preventing bone disease in MM.
Insights
Fractures significantly increase mortality risk for multiple myeloma (MM) patients. Early and later fractures in MM patients indicate a higher risk of death, highlighting the need for bone disease prevention.
Area of Science:
- Hematology
- Oncology
- Orthopedics
Background:
- Multiple myeloma (MM) frequently causes bone lesions.
- The prognostic impact of fractures in MM patients remains incompletely understood.
Purpose of the Study:
- To investigate the association between fractures and survival in a large cohort of Swedish multiple myeloma patients.
- To evaluate the effect of fractures occurring at diagnosis and after diagnosis on MM patient survival.
Main Methods:
- Utilized data from the Swedish Cancer Registry for 14,013 MM patients diagnosed between 1990-2013.
- Employed Cox regression models, adjusting for age, sex, diagnosis year, and prior fractures, to assess survival.
- Analyzed fractures at diagnosis and as a time-dependent variable post-diagnosis.
Main Results:
- 8.7% of patients had fractures at MM diagnosis; 23.1% developed fractures after diagnosis.
- Fractures at diagnosis increased the risk of death (HR=1.28).
- Fractures after diagnosis significantly elevated mortality risk (HR=2.00).
Conclusions:
- Fractures are a significant negative prognostic factor in multiple myeloma.
- Preventing bone disease and managing fractures is crucial for improving survival in MM patients.
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