Beyond Bone Protection: identifying falls risk factors and frailty profiles in the myeloma cohort

Background

Myeloma is a condition of predominantly older adults. Treatment typically includes long term dexamethasone which affects bone health, nutrition and muscle integrity. Myeloma also causes secondary osteoporosis and lytic lesions. No previous studies describe falls risk factors in this cohort. We explore this and associations with frailty status in a tertiary joint Geriatrician & Haematologist Myeloma clinic.

Methods

55 older adults (>65 years) completed a survey about balance concerns (Q1), fear of falling (Q2), falls in last year (Q3) and previous fractures (Q4), age and frailty related questions including those to calculate Clinical Frailty Score (CFS) and Edmonton Frail Scale (EFS). Frailty was defined as present if EFS 6 or above. 

Results

Median age was 75 (range 65-94). 

Balance concerns: 49%. Fear of Falling: 47%. Falls in last 12 months: 31%. Previous Fractures: 11%. 

70.9% responded positively to at least 1 question. 47.2 responded positively to at least 2 questions

Number of concerns: 0: 29.1%, 1: 23.6%, 2: 30.9%, 3: 12.7%, 4: 3.6%

Frailty Scores vs self reported: 

EFS vs number of questions: Mann U Whitney p=0.041, rank-biserial correlation =+0.315.

EFS vs individual questions Chi Squared (Q1: p=0.072, Q2 p=0.116, Q3: p=0.066, Q4: p=0.667)

CFS showed no statistical correlations. 

Discussion

Fractures are likely under-reported and statistical analysis was based on small numbers. 

Presence of frailty did not statistically correlate with individual positive responses but was associated with higher number of questions answered positively. This correlates with the cumulative deficits model of frailty. However individual risks did not show statistical significance. This indicates that individual concerns may be unique to the myeloma cohort. 

Although patients are routinely prescribed bone protection, non-medication falls work-up should still be core to fully manage risk of falls.