Fewer administrations of intravenous bisphosphonate among patients with multiple myeloma had comparable rates of recurrent skeletal-related events (SRE) compared with more frequent dosing. These findings, from a retrospective cohort study, were published in JAMA Network Open.

To assess whether dosing frequency of bisphosphonate effects skeletal-related outcomes, researchers from the University of Illinois at Chicago sourced data from the IBM MarketScan Databases collected between 2009 and 2015. Patients with newly diagnosed multiple myeloma (4281 patients) were assessed for SREs and bisphosphonate therapy regimen. SREs were defined as hypercalcemia, pathological fracture, spinal cord compression, and other events requiring radiotherapy or surgical intervention.

The mean age among patients was 64.8 years and 57.3% were men. The rate of SRE was 96.2 per 100 person-years.

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Most participants (2567 patients) had a baseline SRE. These patients had more comorbidities including osteoporosis (P <.001), history of visits to the emergency department (P <.001), gait abnormalities (P =.04), falls (P =.04), were more likely to receive cytotoxic chemotherapy (P <.001), immunomodulatory imide drugs (P <.001), autologous hematopoietic stem cell transplantation (P <.001), and proteasome inhibitors (P =.001).

Compared with bisphosphonate dosing every 4 weeks, no increased risk for SRE was observed among patients receiving dosing for more than 12 weeks (adjusted hazard ratio [aHR], 0.90; 95% CI, 0.75-1.09; P =.29), 9 to 12 weeks (aHR, 0.95; 95% CI, 0.84-1.08; P =.46), or 5 to 8 weeks (aHR, 1.00; 95% CI, 0.89-1.12; P =.95).

This study was limited by its retrospective, observational design.

The results of this study confirmed previously published findings from randomized clinical trials. No significant difference in SRE risk on the basis of intravenous bisphosphonate dosing was observed for patients with newly diagnosed multiple myeloma.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Zhou J, Sweiss K, Han J, et al. Evaluation of frequency of administration of intravenous bisphosphonate and recurrent skeletal-related events in patients with multiple myeloma. JAMA Netw Open. 2021;4(7):e2118410. doi:10.1001/jamanetworkopen.2021.18410

This article originally appeared on Oncology Nurse Advisor