Certain Patients at Greater Risk for Myeloma-Related Vertebral Fractures

Researchers have identified several factors that may help to predict the progression of vertebral fractures and future fractures in patients with multiple myeloma.

“In the present study, we observed several significant independent predictors of greater fracture progression and developing future fractures,” wrote researcher Roy Xiao, of Cleveland Clinic Center for Spine Health, and colleagues, in the Spine Journal. “Specifically, comorbidities such as hypertension, dyslipidemia, and osteopenia/osteoporosis were found to predict both rapid vertebral body height loss and increased likelihood for developing future fracture.”

According to the study, most patients with multiple myeloma report bone pain in the back or ribs. Studies have shown that between 55% and 70% of patients with myeloma will experience vertebral fractures at some point during the course of their disease.

With this analysis, Xiao and colleagues wanted to identify possible predictors of vertebral fracture progression over time, as well as possible predictors of future vertebral fractures in patients with multiple myeloma.

The study included all patients who presented at a single center between January 2007 and December 2013 with multiple myeloma and pathologic vertebral fracture. The researchers conducted a retrospective chart review of these patients and measured anterior, middle, and posterior vertebral body heights using MRI. The primary endpoint of the study was the rate at which patients lost vertebral body height.

The analysis included 33 patients who presented with 67 fractures. These patients most commonly presented to the center complaining of back pain (82%). At fracture presentation the median vertebral height losses were 30% for anterior, 44% for middle, and 17% for posterior.

The patients were followed for a median of 10.8 months. At this first follow-up visit the median anterior height loss was 44%; middle, 42%; and posterior, 17%. The researchers calculated the median monthly decrease and found a decrease of 0.52% per month for anterior, 0.11% per month for middle, and 0.14% for posterior vertebral height.

Xiao and colleagues then performed a multivariable linear regression and found that time to first follow-up, body mass index, dyslipidemia, previous nonvertebral pathologic fracture related to myeloma, and number of vertebral fractures were all significant independent predictors of the rate of height loss among these patients (P < .05). Specifically, more rapid height loss was associated with a higher BMI, dyslipidemia, and previous nonvertebral fracture related to myeloma.

The researchers also conducted analyses to identify predictors of future vertebral fracture. The median time to future fracture was 25.1 months with a 5-year fracture-free survival of 34%. Four factors were significantly associated with the development of future vertebral fractures: hypertension (P < .01), diabetes (P < .01), osteopenia/osteoporosis (P < .01), and greater serum calcium (P = .05).  However, the researchers wrote to interpret these data with caution, because “there is no known physiologic mechanism for the interaction between hypertension and diabetes with fracture progression.”

“Vertebral fractures significantly impact quality of life in patients with multiple myeloma, and while a dose-response relationship between fracture severity and loss of quality of life has not been documented, such a relationship likely exists,” the researchers wrote. “Thus, early referral to spine clinics for increased surveillance and intervention could deter fracture progression and ultimately improve quality of life.”