African American Patients With Myeloma Received Fewer Bone Drug Doses

African American patients with newly diagnosed multiple myeloma were less likely than White patients to receive drugs that protect against bone damage during their first year of treatment, according to a study from Johns Hopkins Hospital in Baltimore published in JCO Oncology Practice. Those who did receive the drugs got fewer doses, and African American patients who had a bone complication around the time of diagnosis were less likely to have their bone treatment stepped up afterward.

Bone disease is the most common complication of multiple myeloma, and it can lead to skeletal-related events such as fractures caused by the cancer, spinal cord compression or the need for radiation or surgery to the bone. Guidelines recommend bone-modifying agents like Zometa (zoledronic acid) and Xgeva (denosumab) to help prevent these complications in every patient with a new myeloma diagnosis, including those without obvious bone damage, the researchers noted.

"[African American] patients who experience an early [skeletal-related event] are more likely to be undertreated with [bone-modifying agents], potentially placing them at increased risk of recurrent events," the researchers said.

How did bone-modifying drug use in multiple myeloma differ by race?

In the first year after diagnosis, 64% of African American patients received at least one dose of a bone-modifying drug, compared with 77% of White patients.

African American patients who did receive the drugs also got fewer doses over that year, with a median of five doses compared with seven for White patients. The difference held after the researchers took into account factors such as age, kidney function, dental health and socioeconomic conditions in patients' neighborhoods.

Bone treatment was also more often delayed or skipped at diagnosis for African American patients (54% versus 42%). In both groups, the most common reason was waiting for dental clearance (approval from a dentist to start treatment). Once treatment began, pauses happened at similar rates in both groups.

A significant difference showed up among patients whose first myeloma treatment combined four drugs. In that group, 44% of African American patients received a bone-modifying drug, compared with 81% of White patients. Among patients who started with a three-drug combination, the rates were closer (75% and 81%, respectively).

According to the researchers, the lower number of doses among African American patients was unlikely to reflect better control of their myeloma. After one year, a similar share of patients in each group were alive without their cancer growing or spreading (78% and 82%, respectively).

Did African American patients with myeloma have more bone complications?

Bone complications happened at similar rates in African American and White patients. Most occurred within 60 days before or after diagnosis (40% and 50%, respectively). For the rest of the first year, 16% of African American patients and 21% of White patients had a bone complication, and neither difference was large enough to rule out chance.

The picture looked different for patients who had a bone complication early on. African American patients with an early complication were more likely to have another one within the first year than African American patients without one (25% versus 10%). White patients did not show the same pattern.

Based on earlier clinical trials, the researchers considered four or more doses a year to be sufficient. Among patients with an early bone complication, 76% of White patients and 46% of African American patients received at least four doses in the first year.

The researchers noted that earlier studies in patients with prostate, lung and breast cancer found African American patients were less likely to have skeletal-related events despite higher rates of cancer spread to the bone, which may point to differences in bone biology.

What did the multiple myeloma bone disease study measure?

The researchers reviewed the records of 350 patients newly diagnosed with multiple myeloma who started their first treatment at Johns Hopkins Hospital between January 2016 and December 2024. Of those patients, 149 identified as African American or Black and 201 identified as White. The study tracked bone-modifying drug use and skeletal-related events during the first year after diagnosis.

African American patients were younger at diagnosis (median age 64 versus 68), had poorer dental health and lived in neighborhoods with lower socioeconomic status, as measured by the Area Deprivation Index. Cancer stage, kidney function, high-risk genetic features and the number of bone lesions at diagnosis were similar between the two groups, as was the share of patients who started on a three- or four-drug regimen (84% and 86%, respectively).

What are the limitations of the myeloma bone disease study?

The study reflected records from one cancer center, so the findings may not apply to other hospitals or patient populations, the researchers explained. Given repeat skeletal-related events were uncommon in the first year, the analysis relied on the first event after diagnosis, which may underestimate the full burden of bone complications.

The Area Deprivation Index measures conditions at the neighborhood level and may miss economic differences between households in the same area. The researchers also could not capture performance status (a measure of how well a patient can carry out daily activities) or formal eligibility for stem cell transplant.

What does the myeloma bone disease study mean for patients?

An early skeletal-related event may help identify African American patients with myeloma who could benefit from more intensive bone treatment. Previous research suggests less frequent dosing may still lower the risk of bone complications for some patients in this group.

"Further studies are warranted to understand whether higher-intensity [bone-modifying agent] regimens can mitigate the increased [skeletal-related event] risk in this [group of patients]," the researchers wrote.

References

1. Irimia RM, et al. "Racial Disparities in the Management of Myeloma Bone Disease: A Retrospective Cohort Study." JCO Oncology Practice. Published Oct. 1, 2026.

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