Increased risk of death by up to 2.5 times in multiple myeloma patients' fractures...Korea's Big Data Proves First Relationship
Oct 27, 2025
A joint research team led by Professor Park Sung-soo of the Department of Hematology at the Catholic University of Korea's Seoul St. Mary's Hospital and Professor Han Seung-hoon of the Department of Pharmacology at the Catholic University of Korea (co-author Ha Jung-hoon of the Department of Endocrinology at Seoul St. Mary's Hospital and Professor Choi Soo-in of the Department of Pharmacology at Catholic University of Korea) confirmed through large-scale big data analysis in Korea that the risk.
Multiple myeloma is a blood cancer in which plasma cells proliferate abnormally in the bone marrow. According to national cancer registration statistics, 1,961 cases occurred annually in Korea in 2022, and it is known as the second most common blood cancer worldwide. In particular, up to 80% of patients with multiple myeloma are accompanied by osteolytic lesions at the time of diagnosis, which leads to pathological fractures, deteriorating the quality of life of patients and increasing the socioeconomic burden.
The research team compared and analyzed 9,365 patients diagnosed with multiple myeloma from 2009 to 2020 and 9365 general control groups who matched gender and age 1:1 using the National Health Insurance Corporation database. As a result of the analysis, the 6-year cumulative fracture incidence in the multiple myeloma patient group was 10.2%, significantly higher than that of the general control group of 8.3%. Looking at each fracture site, the risk of spinal fractures was 1.36 times higher than that of the general population, and the risk of hip fractures was 1.47 times higher.
In particular, the research team noted that if a fracture occurs within a year after diagnosis of multiple myeloma, the mortality rate increases significantly. The patient group who experienced fractures within a year of diagnosis had a 1.37-fold increased risk of death for all fractures compared to the non-fractured patient group, and the risk of death was significantly increased in all fracture types with 1.39 times for vertebral fractures, 2.46 times for hip fractures, and 1.94 times for upper limb fractures by fracture site. In particular, hip fractures have the worst prognosis, with the risk of death more than doubling.
The high risk of fracture in patients with multiple myeloma is due to bone homeostasis destruction due to infiltration of myeloma cells. Myeloma cells increase osteoclast activity and decrease osteoblast function, causing osteolytic lesions. In addition, the molecular regulation of RANKL (receptor-activated nuclear factor Kappa-B ligand), sclerostin, and Dickkopf-1 released by bone cells is disturbed, changing the bone marrow microenvironment and increasing the risk of fracture. In the case of hip fractures, deterioration of function and long-term bed rest are required, and complications such as pressure ulcers, infections, and pneumonia are likely to occur during this period, leading to an increase in mortality.
The findings of this study, which show that the mortality rate increases significantly when fractures occur within a year of diagnosis, suggest that active drug treatment and patient education are needed to minimize the risk of fracture from the beginning of diagnosis of multiple myeloma. Although there are concerns about side effects from long-term use of anti-bone absorbents, the research team explains that efforts to prevent fractures are essential because the benefits of treatment far exceed the side effects in patients with multiple myeloma.
This study is the first analysis of the relationship between multiple myeloma fractures and death using national insurance data in Korea, and it is meaningful to analyze the incidence of fractures in multiple myeloma patients by part and to identify the relationship between fractures and mortality. In patients with multiple myeloma, it has been found that fractures are not just complications but can be an important prognostic factor directly related to survival, which is evaluated to provide the basis for establishing an active management strategy for fracture prevention in the clinical field.
Professor Ha Jung-hoon, the first author of the study, said "Fractures are not just complications but important factors directly related to survival in patients with multiple myeloma, so active treatment and management are needed to prevent them."
On the other hand, Professor Park Sung-soo, who led the study, said, `This study provides a practical basis for patient treatment strategies using big data in Korea, and shows that fracture prevention management must be carried out in parallel to increase the survival rate of patients with multiple myeloma.' We will use it as a basis for establishing active treatment and management strategies to minimize the risk of fracture.'
The findings were recently published in the international journal 『Scientific Reports』 under Nature Portfolio.
Multiple myeloma is a blood cancer in which plasma cells proliferate abnormally in the bone marrow. According to national cancer registration statistics, 1,961 cases occurred annually in Korea in 2022, and it is known as the second most common blood cancer worldwide. In particular, up to 80% of patients with multiple myeloma are accompanied by osteolytic lesions at the time of diagnosis, which leads to pathological fractures, deteriorating the quality of life of patients and increasing the socioeconomic burden.
The research team compared and analyzed 9,365 patients diagnosed with multiple myeloma from 2009 to 2020 and 9365 general control groups who matched gender and age 1:1 using the National Health Insurance Corporation database. As a result of the analysis, the 6-year cumulative fracture incidence in the multiple myeloma patient group was 10.2%, significantly higher than that of the general control group of 8.3%. Looking at each fracture site, the risk of spinal fractures was 1.36 times higher than that of the general population, and the risk of hip fractures was 1.47 times higher.
In particular, the research team noted that if a fracture occurs within a year after diagnosis of multiple myeloma, the mortality rate increases significantly. The patient group who experienced fractures within a year of diagnosis had a 1.37-fold increased risk of death for all fractures compared to the non-fractured patient group, and the risk of death was significantly increased in all fracture types with 1.39 times for vertebral fractures, 2.46 times for hip fractures, and 1.94 times for upper limb fractures by fracture site. In particular, hip fractures have the worst prognosis, with the risk of death more than doubling.
The high risk of fracture in patients with multiple myeloma is due to bone homeostasis destruction due to infiltration of myeloma cells. Myeloma cells increase osteoclast activity and decrease osteoblast function, causing osteolytic lesions. In addition, the molecular regulation of RANKL (receptor-activated nuclear factor Kappa-B ligand), sclerostin, and Dickkopf-1 released by bone cells is disturbed, changing the bone marrow microenvironment and increasing the risk of fracture. In the case of hip fractures, deterioration of function and long-term bed rest are required, and complications such as pressure ulcers, infections, and pneumonia are likely to occur during this period, leading to an increase in mortality.
The findings of this study, which show that the mortality rate increases significantly when fractures occur within a year of diagnosis, suggest that active drug treatment and patient education are needed to minimize the risk of fracture from the beginning of diagnosis of multiple myeloma. Although there are concerns about side effects from long-term use of anti-bone absorbents, the research team explains that efforts to prevent fractures are essential because the benefits of treatment far exceed the side effects in patients with multiple myeloma.
This study is the first analysis of the relationship between multiple myeloma fractures and death using national insurance data in Korea, and it is meaningful to analyze the incidence of fractures in multiple myeloma patients by part and to identify the relationship between fractures and mortality. In patients with multiple myeloma, it has been found that fractures are not just complications but can be an important prognostic factor directly related to survival, which is evaluated to provide the basis for establishing an active management strategy for fracture prevention in the clinical field.
Professor Ha Jung-hoon, the first author of the study, said "Fractures are not just complications but important factors directly related to survival in patients with multiple myeloma, so active treatment and management are needed to prevent them."
On the other hand, Professor Park Sung-soo, who led the study, said, `This study provides a practical basis for patient treatment strategies using big data in Korea, and shows that fracture prevention management must be carried out in parallel to increase the survival rate of patients with multiple myeloma.' We will use it as a basis for establishing active treatment and management strategies to minimize the risk of fracture.'
The findings were recently published in the international journal 『Scientific Reports』 under Nature Portfolio.
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This article was translated by Naver AI translator.
