Predicting and Preventing Spinal Fractures in Multiple Myeloma Patients After Radiation Therapy

Studies Highlight the Importance of Identifying Risk Factors and Strategies to Reduce Vertebral Compression Fractures

Introduction:

Multiple myeloma, a cancer of the plasma cells, often leads to bone-related complications, including painful spinal lesions and vertebral compression fractures (VCFs). While conventional external beam radiation therapy (cEBRT) is commonly used to alleviate pain and treat spinal cord compression, recent studies suggest that radiation therapy may increase the risk of VCFs in multiple myeloma patients. In this blog post, we will discuss the findings of two important studies that shed light on this issue and propose strategies for predicting and preventing spinal fractures in this vulnerable population.

Study:

Retrospective Multicenter Cohort Study A retrospective multicenter cohort study published in The Spine Journal investigated the incidence of VCFs in multiple myeloma patients who underwent cEBRT to the spine. The study, conducted by Hester Zijlstra, MD, and colleagues, included 127 patients with a total of 427 irradiated vertebrae. The results showed that nearly one-third (30.7%) of the patients developed new or progressed VCFs within three years of receiving cEBRT. The study also found that the Spinal Instability Neoplastic Score (SINS) was independently associated with the development of these fractures, suggesting its potential use in predicting VCFs in multiple myeloma patients.

Strategies for Prediction and Prevention:

Given the high incidence of VCFs after cEBRT in multiple myeloma patients, it is crucial to identify risk factors and implement strategies to predict and prevent these fractures. The study discussed above highlight the importance of using the SINS score to assess fracture risk in this patient population. By incorporating the SINS score into clinical decision-making, healthcare providers can identify patients at higher risk of VCFs and consider alternative treatment options or additional supportive measures.

Furthermore, the use of bisphosphonates, a class of drugs that help strengthen bones and reduce fracture risk, was found to be independently associated with a lower rate of new or progressed VCFs in one of the studies. This finding underscores the importance of considering bisphosphonate therapy as a preventive measure in multiple myeloma patients undergoing cEBRT.

Conclusion:

By utilizing the SINS score and considering preventive measures such as bisphosphonate therapy, healthcare providers can work towards reducing the occurrence of these painful and debilitating fractures, ultimately improving the quality of life for multiple myeloma patients undergoing radiation therapy.