Vertebral Fractures and Myeloma: Link Is Questionable
SAN DIEGO — Incidentally discovered vertebral fractures are common on scans in the general population, while the absolute risk for multiple myeloma (MM) in those with such fractures is “quite modest,” according to findings from a Danish cohort of over 9,000 patients.
The findings suggest that evaluation for underlying MM — as recommended in some clinical guidelines — may not be necessary in the absence of symptoms or other clinical indicators suggesting MM, Rasmus Rønnemoes, MD, reported during a poster session at the annual American Society of Hematology conference.
“Some guidelines suggest evaluating patients with vertebral fractures, including measuring serum M-protein and free light chains, while others indicate that evaluation should occur only if there is a clear indication,” Rønnemoes stated in an interview.
To explore the relationship between vertebral fractures and MM, researchers analyzed data from 9,065 individuals aged 33-94 years (median age 62) who participated in the Copenhagen General Population Study. All participants underwent a health examination and a CT scan as part of the study. The results showed that 1,574 (17.4%) of participants had one or more incidentally discovered vertebral fractures on the CT scan. Among these, 875 (9.7%) had grade 1 fractures, while 699 (7.7%) had grade 2-3 fractures.
During a median prospective follow-up of 5.5 years post-scan, 13 individuals were diagnosed with myeloma.
“We discovered an increased relative risk of myeloma in these patients, which was interesting, but the absolute risk was quite modest,” Rønnemoes noted.
The absolute 5-year risk for MM in the general population was 0.07% for women and 0.10% for men without vertebral fractures. Conversely, for those with grade 1 fractures, the risk increased to 0.17% for women and 0.24% for men, while for grade 2-3 fractures, the risk was 0.43% for women and 0.63% for men.
A case-cohort study based on over 56,000 individuals from the UK Biobank cohort who underwent a dual-energy x-ray absorptiometry scan corroborated the findings from the Danish population. With a median follow-up of 4 years, 49 patients in the validation cohort were diagnosed with myeloma. The absolute 5-year risk for myeloma was found to be 0.06% for women and 0.12% for men with grade 1 fractures, and 0.14% for women and 0.26% for men with grade 2-3 fractures.
Given the modest absolute risk for MM in patients with incidentally discovered fractures in the absence of strong indications, treatment guidelines should take into account the potential harms associated with further evaluations and diagnoses of monoclonal gammopathy of undetermined significance. Such a diagnosis can induce psychological distress for individuals who may never develop malignant disease.
“We aim to enhance the value of the guidelines by clearly identifying who should be evaluated,” Rønnemoes commented, noting that further research is warranted to determine if only the more severe fractures should trigger additional evaluation.
