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Osteoporosis is highly prevalent, and how this comorbidity contributes to outcomes in individuals who develop multiple myeloma (MM) is unknown. Using the Women’s Health Initiative dataset (n = 362), factors were evaluated in women who later developed MM. Higher fracture risk, measured by the Fracture Risk Assessment Tool, was associated with higher mortality (covariate-adjusted hazard ratio, 1.51; 95% confidence interval, 1.01-2.25; P = .044) in postmenopausal women who develop MM, independent of other clinical factors.Multiple myeloma (MM) is a disease of aging adults resulting in osteolytic and/or osteoporotic bone disease. Primary osteoporosis is also highly prevalent in aging adults and is associated with increased mortality. It is unknown how concurrent osteoporosis is associated with outcomes in patients who develop MM.We identified 362 women with MM of the 161,808 enrolled in the Women’s Health Initiative (WHI) dataset and evaluated bone health using the Fracture Risk Assessment Tool (FRAX) to identify clinical factors that affect overall MM survival in post-menopausal women, as measured from the time of diagnosis.Of the 362 participants who developed incident MM, with an average 10.5 years of follow-up, 226 died, including 71 with high FRAX scores and 155 with low FRAX scores. On average, women with high FRAX scores were 8.3 years older at enrollment (95% confidence interval [CI], 7.2-9.3 years) and 8.0 years older at time of MM diagnosis (95% CI, 7.0-9.2 years) compared with those with low FRAX scores. MM mortality for women with high FRAX scores was greater (covariate-adjusted hazard ratio scores [aHR] 1.51; 95% CI, 1.01-2.25; P = .044) compared with those with low FRAX scores.Higher fracture risk, measured by FRAX, was associated with higher MM mortality in post-menopausal women, independent of many other clinical factors.