Pathological fracture cancer8/28/2023 ![]() In the largest study so far, a total of 513 MM patients diagnosed from 1998 to 2000 and enrolled in a clinical trial were included retrospectively all patients had Durie-Salmon stage III, bone lesions, and a median age of 62 years. 16 14 To our knowledge, only three studies have assessed the effect of fractures on survival in MM. Previous studies have shown that skeletal-related events (radiation to the bone, a pathologic or osteoporotic fracture, hypercalcemia, spinal cord compression, or surgery to the bone) are associated with reduced survival in both breast cancer and prostate cancer. 5 To prevent skeletal-related events, treatment with bisphosphonates is recommended for most patients with MM, and treatment with zoledronic acid has been reported to improve overall survival in MM patients. 11 10 5 In a population-based retrospective study, MM patients were found to have a 9-fold increase in risk of fractures after MM diagnosis, as compared to expected fracture rates in the population. 9 8 This imbalance, along with decreased bone mineral density and treatment-related factors such as treatment with glucocorticoids, can lead to fractures in MM. 7 6 In MM bone disease, the interaction between malignant plasma cells and the bone microenvironment leads to osteoclastic bone destruction, reduced osteoblast function, and blocking of bone repair. 5 3 Bone disease can be painful and reduces quality of life in MM patients. 2 1 Skeletal abnormalities are found in the majority of MM patients at the time of diagnosis, and manifestations of bone disease in MM include osteolytic lesions, osteopenia/osteoporosis, and fractures. Multiple myeloma (MM) is a malignant neoplasm of plasma cells in the bone marrow. 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. The impact of fractures on survival did not change significantly between the two calendar periods 13 (0.98 0.89-1.08). The risk of death was significantly increased in patients with a fracture after MM diagnosis (2.00 1.90-2.10). 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). 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. Results were adjusted for age, sex, year of diagnosis, and previous fractures. 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. Information on date of birth, MM diagnosis, fractures, and death was collected from central registries. 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. The impact of fractures on multiple myeloma (MM) survival is unclear. Multiple myeloma causes lytic bone lesions and fractures.
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