Racial Disparities in the Management of Myeloma Bone Disease: A Retrospective Cohort Study

Purpose Skeletal-related events (SREs) are major contributors to morbidity in multiple myeloma (MM) and can be partially prevented with antiresorptive bone-modifying agents (BMAs). African American (AA) patients differ in incidence, disease biology, and outcomes. However, the characteristics and management of SREs in this population remain poorly defined. Methods We conducted a retrospective cohort study of 350 patients newly diagnosed with MM (149 AA, 201 White), treated at the Johns Hopkins Hospital between 2016 and 2024. We assessed racial differences in SRE incidence, severity, and timing, as well as BMA administration during year 1 after diagnosis. Results The proportion of patients receiving BMAs within the first year was significantly lower among AA patients than among White patients (64% v 77%, P = .013), with AA patients also receiving significantly fewer doses (median 5 v 7 doses/year, P < .001) among BMA-treated patients. Most of the SREs in both groups occurred during the peridiagnostic period (40% v 50%, P = .06). Beyond the peridiagnostic period, the 1-year cumulative SRE incidence did not differ significantly (16% v 21%, P = .24). Among AA patients, those with a peridiagnostic SRE had a significantly higher incidence of subsequent SREs compared with those without an early event ( P = .02) and, compared with White patients with a peridiagnostic SRE, were less likely to receive at least 4 BMA doses during the first year (46% v 76%, p -adjusted < .001). Conclusion AA patients with MM receive overall lower-intensity dosing of BMAs, yet experience no significant difference in postdiagnostic SREs during the first year. However, AA patients who experience an early SRE are more likely to be undertreated with BMAs, potentially placing them at increased risk of recurrent events.