Pre-Cancer Bone Health May Help To Predict Myeloma Outcomes

When it comes to multiple myeloma, patients’ bone health can have major implications on their outcomes — even before they are diagnosed, according to recent research conducted by Ashley Rosko, M.D.

Rosko, who is an assistant professor at The Ohio State University Comprehensive Cancer Center, and her team used the Women’s Health Initiative (WHI) to track women’s bone health, and if they developed myeloma, their outcomes. In particular, the researchers looked at factors such as osteoporosis and FRAX score (a scale to determine if an individual is at a higher risk to develop bone fractures).

In an interview with CURE, Rosko explained her findings.

Can you give an overview of your study and its findings?

I'm a multiple myeloma physician here at Ohio State, I specialize in health outcomes, looking at factors that can contribute to adverse outcomes in older adults, specifically. So, what we did is we looked at a registry using the WHI. It's one of the largest longitudinal studies of post-menopausal women. In that study, there were many women who developed cancers over the course of time. One of the cancers that those women developed was multiple myeloma, a blood cancer that affects bones.

What we were able to identify within that is that we wanted to really evaluate factors that contributed to adverse outcomes for women who developed myeloma. What we found is that for women who enrolled into that study, many years before they even developed cancer, who had osteoporosis, as defined by a high FRAX score, were at higher risk for complications and death, actually, later on when they developed multiple myeloma.

Osteoporosis is really common. So, sometimes when it comes to multiple myeloma, it's hard for us to tell the difference between myeloma-related bone disease and osteoporosis-related bone disease. Within our study, we found that for people who came in with these high FRAX scores, many years prior to their diagnosis, in fact seven to nine years before, that those women were at higher risk for mortality.

If a woman has a high FRAX score or osteoporosis, but not myeloma, should they be concerned about getting the disease?

One of the things that pre-dates nearly all patients who have multiple myeloma is a benign condition called monoclonal gammopathy of undetermined significance (MGUS). It's not a pre-cancer, but it's a condition that can sometimes happen as people age. What we're finding out is that for people who have MGUS, it contributes to poor bone health development. We work closely with endocrinologists, so for people who have osteoporosis and MGUS together, we watch them a little more carefully and are screening them if they develop more factures. Then we're at a higher clinical suspicion that something is going on.

So, for women who come in who have osteoporosis and MGUS, we often work with our endocrinology team to make sure that they don't have an underlying cancer.

What would be the grand takeaway for patients or others who are hearing about this research?

One of the takeaways for this is that for a common condition like osteoporosis and for a less common disease like multiple myeloma, and for people who have an increased risk for fractures and who have a carried condition of MGUS, it's always reasonable for them to see a hematologist just to make sure there isn't any underlying problems or developing problems over time.

Are there any other unanswered questions in this field?

When it comes to patients who have MGUS, this benign condition associated with aging but that can be associated with myeloma too, this really opens the field for us to be able to better understand the relationship between MGUS and osteoporosis. Does MGUS accelerate osteoporosis? This is an unanswered question, and this is an area where there needs to be further research for us to be able to understand the relationship between MGUS and osteoporosis. Or to see if women who have osteoporosis, whether or not screening is indicated for this condition for MGUS.

Once a patient is already diagnosed with myeloma, how can they pay attention to their bone health and be proactive?

When someone is diagnosed with multiple myeloma, we're really far along with optimizing skeletal care. It's well-established for patients to receive bisphosphonate therapy to be able to support their bone health, to be able to decrease bone pain and skeletal-related events. It's a well-established means for us to provide bisphosphonate therapy for patients with or without fractures. That field is pretty well-established.

In this manuscript, it's really identifying people before they develop multiple myeloma. How can we optimize bone health, or what do we further need to know about their bone health prior to their diagnosis?