The NHS has recently introduced Fracture Liaison Services to investigate patients who have suffered a fragility fracture for underlying causes such as osteoporosis with the aim of reducing the risk of further fractures.
Although multiple myeloma is an incurable cancer, there is still benefit in earlier diagnosis to improve prognosis. However, its non-specific symptoms means that diagnosis is frequently delayed. Both myeloma and its precursor, monoclonal gammopathy of undetermined significance (MGUS), are associated with bone fragility. Indeed, 1 in 20 patients with newly diagnosed osteoporosis have underlying myeloma or MGUS, which suggests that benefits may arise from screening patients with fractures for myeloma. In 2019, the Royal Osteoporosis Society recommended that all patients attending a Fracture Liaison Service have serum and urinary laboratory investigation for myeloma but the impact of this additional screening remains unclear.
In this paper published in Osteoporosis International, Dr Gaurav Agarwal (Oxford University Hospitals NHS Trust) studied 950 patients seen by the Oxfordshire Fracture Liaison Service. 628 patients were eligible for myeloma screening using standard techniques (serum electrophoresis, serum free light chain analysis and/or urine electrophoresis). This investigation identified 1 in 195 patients with myeloma and 1 in 13 patients with MGUS that may otherwise have been missed. These patients were referred to Haematology Services for urgent investigation or their GP, respectively.
While these findings show that screening in Fracture Liaison Services is promising for diagnosing myeloma earlier, further analysis of the longer term outcomes are needed to define the value of diagnosing MGUS in this setting and to evaluate the health economics.