S05:5 | Romosozumab in Post-Menopausal Women with Multiple Myeloma, a Prospective 12-Month Study

Giovanni Adami¹, Mariana Diz Lopes¹, Camilla Benini¹, Davide Gatti¹, Ombretta Viapana¹, Elena Marchetti², Martina Tinelli², Maurizio Rossini¹ | ¹UOC Reumatologia, Università degli Studi di Verona Verona, Italy; ²UOC Ematologia, Università degli Studi di Verona Verona, Italy

Background. Bone damage occurs early in the progression of plasma cell disorders. Romosozumab (ROMO), a sclerostin inhibitor with both anabolic and antiresorptive effects, may provide therapeutic benefit for this fracture-prone population.

Methods. We conducted a 12-month prospective observational study on postmenopausal women with osteoporosis and multiple myeloma (MM) treated with monthly ROMO. BMD was assessed at baseline, 6, and 12 months with DXA. HR-pQCT, bone turnover makers and several MM markers (M-protein, immunoglobulins, free light chains, b2-microglobulin) were monitored. Repeated measures were analyzed using mixed-effects models.

Results. Eight female patients with MM without evidence of CRAB (mean age 67.4±9.9 years) completed 12 months of ROMO. A significant BMD increase was observed at the lumbar spine (+5.8%, p=0.048), femoral neck (+4.2%, p=0.020), and total hip (+3.3%, p=0.002). P1NP rose sharply at month 3 (+117.8%) and returned to baseline by month 12 (p=0.006). CTX decreased progressively, showing a trend towards significance (-53.6%, p=0.060). ALP and B-ALP significantly declined by month 12 (p=0.020 and p=0.022). No significant changes occurred in immunoglobulins, M-protein, or light chains. B2-microglobulin decreased at month 12 (from 2.35 to 2.1mg/L, p=0.042), but the overall trend was not significant (p=0.092). Estimated failure load increased at month 6 (p=0.033) while the other HR-pQCT parameters remained stable throughout the study.

Conclusions. In this exploratory study of postmenopausal women with MM and osteoporosis, ROMO significantly improved BMD and modulated BTMs, without any evidence of disease progression over the 12-month period. These findings support ROMO as a potential bone-targeted therapy in patients with osteoporosis and MM.