Incidence of first and subsequent fractures in multiple myeloma patients: a parallel cohort study using UK CPRD dataset.

UNLABELLED: Based on a UK primary care dataset, patients with Multiple Myeloma (MM) experience a significantly higher index fracture rate from 1 year prior to MM diagnosis onwards and a higher subsequent vertebral fracture rate, compared to non-MM controls. There is potential for earlier MM diagnosis and reducing subsequent fracture risk. PURPOSE: Whilst multiple myeloma (MM) is known to increase fracture risk, the incidence of subsequent fractures is poorly described. Here, we describe the incidence of index and subsequent fractures in a real-world cohort of MM patients, compared to non-MM controls. METHODS: Using the UK Clinical Practice Research Datalink GOLD, we identified a MM cohort with age-, sex-, and GP-practice-matched controls from 1995 to 2017. The primary outcome was the incidence of fracture at major osteoporotic sites (i.e. hip, vertebral, wrist, or humerus) within 2 years before and after MM diagnosis. The cumulative incidence of subsequent fractures up to 2 years post-index fracture was estimated using Cox proportional hazards models. RESULTS: A total of 1972 patients (54.7% male, median age 70 years) with MM were matched to 6413 non-MM controls. The index fracture rate was significantly greater in the MM cohort compared to the non-MM cohort from 1 year prior to MM diagnosis onwards. Post-index fracture, the overall 2-year subsequent major fracture rate was 14.7% (95% CI:11.4-20.5) and 14.6% (95% CI:10.8-19.2) in the MM and non-MM cohorts, respectively. Within 2 years post-index fracture, the risk of subsequent vertebral fracture was significantly greater in MM patients (aHR: 8.16 (95% CI: 1.84-36.1), p = 0.006). CONCLUSIONS: MM patients are at higher risk of having an index fracture from 1 year pre-diagnosis and a subsequent vertebral fracture in the 2 years post-index fracture, compared to non-MM controls. These findings highlight the potential for earlier MM diagnosis in adults presenting with a major fracture, and the need to reduce subsequent fracture risk.