title: Radiologic and clinical characteristics of vertebral fractures in multiple myeloma.
abstract: BACKGROUND
  Nearly 80% of patients with newly diagnosed multiple myeloma (MM) have bony lesions on magnetic resonance imaging (MRI). These lesions may progress to debilitating vertebral fractures. No studies have quantitatively characterized these fractures or identified predictors of fracture burden and severity.
  
  
  OBJECTIVE
  The purpose of this study was to characterize the clinical and radiologic features of these fractures and to identify independent predictors of fracture burden and severity.
  
  
  METHODS
  A consecutive retrospective chart review was conducted from January 2007 to December 2013 at a single tertiary-care institution.
  
  
  METHODS
  Patients with diagnoses of both MM and vertebral fracture were included in this study. Those with a history of non-MM vertebral fracture were excluded.
  
  
  METHODS
  The primary outcome measure was height loss of the fractured vertebral body, whereas secondary outcome measures included number of fractures and morphology.
  
  
  METHODS
  Data were collected at fracture presentation. Radiologic data were obtained from T1-weighted MRI. Anterior, middle, and posterior vertebral body height losses were recorded, and a Genant grading was made. Multivariable Poisson and logistic regression were performed to identify predictors of fracture burden and severity.
  
  
  RESULTS
  Among 50 patients presenting with vertebral fracture, 124 fractures were observed. The majority (76%) of these patients did not have a previous MM diagnosis. The most common presenting symptom was back pain (84%), followed by neurologic (54%) and constitutional (50%) symptoms. The mean anterior, middle, and posterior height losses of the fractured vertebral body were 30%, 37%, and 16%, respectively. Twenty percent of fractures were Genant Grade 1 (mild), whereas 32% and 48% were grades 2 (moderate) and 3 (severe). Fifty-five percent of fractures were biconcave, whereas 32% and 13% were wedge and crush fractures. Lower body mass index and albumin and increased myeloma protein, light chains, and creatinine predicted an increased number of fractures at presentation. Increased β2-microglobulin and creatinine predicted more severe vertebral fractures.
  
  
  CONCLUSIONS
  In the present study, 124 fractures were observed among 50 patients. These fractures were generally severe, biconcave, and in the thoracic spine. Laboratory signs of advanced MM predict greater fracture burden and severity. In the future, monitoring of these predictors may raise suspicion for an MM-associated vertebral fracture.
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., NA-24, Cleveland, OH, 44195, USA.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Miller
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., NA-24, Cleveland, OH, 44195, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bowen
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., NA-24, Cleveland, OH, 44195, USA.
authors.forename: Megan V
authors.initials: MV
authors.lastname: Morisada
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Margetis
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., NA-24, Cleveland, OH, 44195, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lubelski
authors.affiliation: Texas Back Institute, 6020 West Parker Rd. #200, Plano, TX, 75093, USA.
authors.forename: Isador H
authors.initials: IH
authors.lastname: Lieberman
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., NA-24, Cleveland, OH, 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., NA-24, Cleveland, OH, 44195, USA. Electronic address: mrozt@ccf.org.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mroz
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000175:diagnosis; D011859:Radiography; D016103:Spinal Fractures / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology
keywords: Genant grading; Height loss; Imaging; Multiple myeloma; Plasmacytoma; Vertebral fractures