The incidence of vertebral compression fractures and spinal instability in newly diagnosed multiple myeloma patients

Multiple myeloma (MM) is a hematologic malignancy, characterized by clonal proliferation of plasma cells in the bone marrow. These plasma cell proliferations frequently result in scattered osteolytic bone lesions and extensive skeletal destruction. Myeloma bone lesions are frequently located in the...

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Bibliographic Details
Published in:Journal of orthopaedics 2023-04, Vol.38, p.62-67
Main Authors: Zijlstra, Hester, Wolterbeek, Nienke, Ponds, Noa H.M., Koene, Harry R., Terpstra, Wim E., Delawi, Diyar, Kempen, Diederik H.R.
Format: Article
Language:English
Subjects:
Incidence
Multiple myeloma
Original article
SINS
Survival
Vertebral fracture
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Summary:Multiple myeloma (MM) is a hematologic malignancy, characterized by clonal proliferation of plasma cells in the bone marrow. These plasma cell proliferations frequently result in scattered osteolytic bone lesions and extensive skeletal destruction. Myeloma bone lesions are frequently located in the spine, and are associated with debilitating bone pain and an increased rate of pathologic fractures and mortality. The aim of this study was to investigate the incidence of vertebral compression fractures (VCFs) and spinal instability in patients with MM. Newly diagnosed patients with MM with computed tomography (CT) scans of the spine within three months of diagnosis were identified through an electronic patient database. Clinical baseline data were manually extracted from the patient charts. Fractured levels were graded on CT scans following the Genant grading system, and spinal instability was assessed through the Spinal Instability Neoplastic Score (SINS). A total of 385 patients with 6289 eligible vertebrae were eligible for inclusion. The mean age at diagnosis was 67 years, and 60% were male. At least one VCF was present in 180 patients (47%). A quarter of fractures were classified as severe. The incidence of fractures increased with more advanced disease stages, and men were more likely to have a fracture than women. Our data show that 47% of MM patients present with one or more VCFs at the onset of their disease, of which 20% were classified as unstable, meaning a surgical consultation is recommended. •About 47% of newly diagnosed multiple myeloma patients present with one or more VCFs at the time of their diagnosis.•18% of the fractured vertebrae are unstable at baseline, meaning a surgical consultation is recommended.•The baseline incidence of fractures is higher in patients diagnosed in a more advanced disease.•The presence of vertebral fractures at baseline does not seem to influence survival of multiple myeloma patients.
ISSN:0972-978X
0972-978X
DOI:10.1016/j.jor.2023.03.008