From the Guidelines
Multiple myeloma bone disease is a common complication of multiple myeloma characterized by bone destruction, pain, fractures, and hypercalcemia, and its treatment should include bisphosphonates and denosumab to prevent skeletal-related events and improve quality of life and survival, as recommended by the American Society of Clinical Oncology clinical practice guideline update 1.
Definition and Pathophysiology
Multiple myeloma bone disease occurs when myeloma cells disrupt the normal balance between bone formation and breakdown by stimulating osteoclasts (bone-destroying cells) while inhibiting osteoblasts (bone-forming cells) 1. This imbalance leads to osteolytic lesions, which appear as "punched-out" areas on X-rays.
Treatment and Management
Treatment for multiple myeloma bone disease includes:
- Bisphosphonates (typically given intravenously every 3-4 weeks)
- Denosumab (a RANK ligand inhibitor)
- Pain management
- Radiation therapy for localized bone pain
- Surgical intervention for fractures or spinal cord compression Calcium and vitamin D supplementation may be needed unless hypercalcemia is present 1.
Osteonecrosis
Osteonecrosis, often confused with osteoporosis, refers to the death of bone tissue due to insufficient blood supply. In multiple myeloma patients, osteonecrosis of the jaw (ONJ) can occur as a side effect of bisphosphonate therapy, particularly with zoledronic acid or pamidronate, which are medications used to treat myeloma bone disease 1.
Guidelines and Recommendations
The European Myeloma Network guidelines for the management of multiple myeloma-related complications emphasize the importance of prophylaxis and supportive treatment for osteolytic disease, pain, anemia, renal insufficiency, infections, pain, thromboembolic events, and peripheral neuropathy 1. The American Society of Clinical Oncology clinical practice guideline update recommends bisphosphonate therapy for all patients with active multiple myeloma, regardless of the presence of lytic bone disease, to reduce skeletal-related events and improve progression-free survival 1.
From the Research
Multiple Myeloma Bone Disease Definition
- Multiple myeloma (MM) is a hematologic malignancy characterized by the proliferation of monoclonal plasma cells localized within the bone marrow 2.
- Bone disease with associated osteolytic lesions is a hallmark of MM and develops in the majority of MM patients 2, 3.
- Myeloma bone disease is marked by severe dysfunction of both bone formation and resorption, leading to purely osteolytic lesions 3.
Osteareosis
- There is no direct mention of "osteareosis" in the provided studies, however, osteolytic lesions and bone resorption are discussed as key components of multiple myeloma bone disease 2, 3, 4.
- The imbalance between bone regeneration and bone resorption underlies the pathogenesis of osteolytic bone disease, leading to progressive bone loss and lytic lesions 4.
Treatment and Management
- The use of osteoclast inhibitory therapies with bisphosphonates, such as zoledronic acid, and the RANKL inhibitor denosumab, have been shown to delay and lower the risk of skeletal-related events (SREs) 2, 5, 6.
- Denosumab has been demonstrated to reduce bone-related events in patients with MM as effectively as zoledronic acid, but may present a safer profile for patients with renal impairment 5, 6.
- Current therapies targeting myeloma bone disease focus on preventing osteoclastic bone destruction, and regulators of osteoblast inhibition in myeloma bone disease have also been identified 3.