Introduction/Purpose: Multiple myeloma (MM) is a malignant disease of plasma cells, characterized by their uncontrolled proliferation in the bone marrow, leading to bone destruction. In MM, the interaction between malignant plasma cells and the bone microenvironment leads to osteoclast bone destruction, reduced osteoblast function, and blockage of bone regeneration. This imbalance, together with decreased bone mineral density and treatment-related factors such as glucocorticoid therapy, can lead to MM fractures. The aim of our study was to evaluate the characteristics, distribution, and frequency of pathological fractures in patients diagnosed with multiple myeloma.
Materials and methods: We retrospectively analyzed the laboratory tests and the results of 29 patients with a total of 45 PET/CT tests, which revealed pathological fractures in 16 (55.18%) men and 13 (44.82%) women. Based on the mean values of SUVmax, the correlation with both laboratory results and clinical stage was examined.
Results and discussion: The distribution of pathological fractures by location was as follows: vertebrae: 12 (41.37%), ribs: 9 (31.03%), clavicles: 2 (6.9%), humerus: 2 (6.9%), femurs: 2 (6.9%), pubic bones: 2 (6.9%). In 14 (48.28%) patients, one pathological fracture was found, and in 15 (51.72%), two or more were found as well. In the comparison, no significant correlation was found between laboratory values (hemoglobin, lactate dehydrogenase, creatinine, and alkaline phosphatase) and the value of SUVmax in pathological fractures in patients referred for staging (p-value = 0.9932). In the comparison, no significant correlation was found between the clinical stage and the value of SUVmax in pathological fractures (p-value = 0.9840).
Conclusion: The study found that the most common pathological fractures are in the vertebrae. No correlation was found between the clinical stage, laboratory results (hemoglobin, lactate dehydrogenase, creatinine, and alkaline phosphatase), and SUVmax values in pathological fractures. The study was retrospective and based on a small cohort of patients. We cannot be sure whether our conclusions are applicable to other or larger cohorts. More research is needed to confirm our findings.
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