Screening for multiple myeloma has low yield as part of a secondary osteoporosis screen

Multiple myeloma (MM) is a secondary cause of osteoporosis, and universal screening is recommended post fragility fracture. However, the longitudinal yield of this approach has not been evaluated. We aimed to assess the yield of the secondary osteoporosis screen in the Austin Health Fracture Liaison Service (FLS) database between 1 June 2009 and 1 June 2014. Patient demographics, fragility fracture type, bone density, and pathology results, including serum protein electrophoresis (SPE), urine Bence Jones protein (BJP), and serum free light chains, were extracted. SPE results were classified as normal, inflammatory, or monoclonal [including monoclonal gammopathy of undetermined significance (MGUS) or MM]. Over 5 years, 1026 initial SPE results were available for 1592 confirmed fragility fractures in 1589 patients who accepted the FLS invitation. The median age was 72 years (IQR 62-81), 26% were men, and 24% sustained a hip or pelvic fracture. Screening for MM was performed a median of 7 days (IQR 3-35) post fracture and revealed 796 (78%) normal, 179 (17%) inflammatory, and 51 (5%) monoclonal results. Repeat SPE for 121 patients with initial inflammatory SPE results yielded an additional six monoclonal results. The monoclonal cohort was followed for a median of 4.4 years (IQR 2.4-7.5); this yielded 4.2% MGUS and 0.3% MM diagnoses. The total cost of universal MM screening was AUD $88,638. The yield of myeloma screening was low and associated with a significant cost. All new MM cases were already flagged by other routine pathology tests.