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

Journal article

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 1995-2017. The primary outcome was the incidence of fracture at major osteoporotic sites (i.e. hip, vertebral, wrist or humerus) within two years before and after MM diagnosis. The cumulative incidence of subsequent fractures up to two years post-index fracture was estimated using Cox proportional hazards models.

Results: 1,974 patients (59.6% male, median age 70 years) with MM were matched to 6,429 non-MM controls. The index fracture rate was significantly greater in the MM cohort compared to non-MM cohort from one year prior to MM diagnosis onwards. Post-index fracture, the overall 2-year subsequent major fracture rate was 16.4% (95% CI:11.1-21.5) and 12.0% (95% CI:7.50-16.30) in the MM and non-MM cohorts, respectively. Within two years post-index fracture, the risk of subsequent vertebral fracture was significantly greater in MM patients (aHR: 11.6 (95% CI:1.47-91.8), p=0.02)).

Conclusions: MM patients are at higher risk of having an index fracture from one year pre-diagnosis and a subsequent vertebral fractures in the two 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.

Authors: Vijjhalwar, R; Song, K; Clemeno, F; Sanchez-Santos, M; Hawley, S

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Springer
• Journal: Osteoporosis International
• Publication date: 2026-01-26
• Acceptance date: 2025-12-15
• DOI: 10.1007/s00198-025-07825-2
• EISSN: 1433-2965
• ISSN: 0937-941X
• Language: English
• Keywords: multiple myeloma; Clinical Practice Research Datalink (CPRD) GOLD dataset; index fracture; imminent fracture risk; vertebral fracture; non-hip fracture