The role of serum macrophage inflammatory protein‐1 alpha (MIP‐1α) in bone disease and survival was evaluated in 85 newly diagnosed multiple myeloma (MM) patients. MIP‐1α was elevated in MM patients and correlated with the extent of bone disease, bone resorption markers and levels of soluble receptor activator of nuclear factor‐κB (RANK) ligand. MIP‐1α was also associated with survival; the 3‐year probability of survival was 85% and 44% for MIP‐1α levels below and above 48 pg/ml respectively (P = 0·021). This suggests that MIP‐1α contributes to the pathogenesis of bone disease in MM and possibly in tumour growth, as reflected by its impact on survival.