Risk factors and clinical impact of bone pain in patients with multiple myeloma - A prospective interdisciplinary...

Bone pain affects up to 80% of patients with multiple myeloma (MM) patients and significantly impairs quality of life (QoL), yet its specific predictors remain poorly characterized. Identifying risk factors is essential for early intervention and personalized treatment.

This prospective, single-center study included 352 patients. Bone pain was recorded using a standardized questionnaire. Multivariate logistic regression with stepwise selection was used to identify independent predictors of bone pain. QoL and health-related status were assessed on a 7-point scale and compared using the Wilcoxon two-sample test.

Bone pain was reported by 184 patients (52%). Independent predictors of bone pain were osteolytic lesions with fracture risk (OR 3.06, 95% CI 1.46-6.40, p = 0.003) and pre-existing orthopedic disease (OR 2.78, 95% CI 1.77-4.36; p < 0.0001). CRAB (hypercalcemia, renal failure, anemia, bone lesions)-B at initial diagnosis (OR 1.74, 95% CI 0.92-3.29, p = 0.09) and progressive disease (OR 1.68, 95% CI 0.93-3.05, p = 0.09) showed an elevated risk for bone pain. No associations were observed for age, sex, CRAB-C/-R/-A, International Staging System (ISS) stage, and disease duration after adjustment. Patients with bone pain had significantly lower median QoL and health-related status compared to patients without pain (p < 0.001).

Osteolytic lesions with fracture risk and pre-existing orthopedic conditions independently predict bone pain in patients with MM. These findings highlight the different etiology and the overlap between orthopedic and oncological conditions. Interdisciplinary management is essential to distinguish MM-caused pain from degenerative pain and optimize individualized care.