Reviewing treatment options for bone disease in patients with multiple myeloma

This article reviewed different treatment options for multiple myeloma (MM)-related bone disease. 

MM is a type of cancer of the bone marrow that can lead to abnormal immune cells. Up to 80% of newly diagnosed patients develop bone disease. These patients have a high risk of bone problems, such as fractures and spinal cord compression. These complications increase the burden of disease on patients and reduce their quality of life.

Bisphosphonates (BPs) such as zoledronic acid (Zometa) are the gold standard in preventing bone loss in patients with cancer. However, other agents are also available, such as denosumab (Xgeva). Other treatment options include surgery and radiation therapy.

In addition to zoledronic acid, other BPs include pamidronic acid (Aredia) and clodronic acid (Bonefos). The authors recommend BP treatment for at least 12 months to all patients with MM, regardless of bone disease. Studies have found that zoledronic acid is more effective than pamidronic acid for patients with high calcium levels in the blood. One study of 1018 patients showed that zoledronic acid reduced the risk of bone problems by 25% and the risk of mortality by 22%. However, more patients treated with zoledronic acid developed bone weakening and loss in the jaw compared to pamidronic acid (2.6% vs. 0.8%). However, most cases of this bone loss healed after about four months, after which treatment can resume.

Zoledronic acid has been shown to also improve long-term outcomes compared to clodronic acid. One study included data from 1960 patients. 981 patients received zoledronic acid, and 979 patients received clodronic acid. Significantly fewer patients given zoledronic acid had bone-related problems and bone pain than patients given clodronic acid (27% vs. 35%). Zoledronic acid treatment was significantly associated with a 12% lower risk of tumor growth or spread and a 16% lower risk of mortality.

Denosumab is an antibody therapy used to help prevent bone loss. The authors recommend denosumab for patients with newly diagnosed, recurrent, or unresponsive MM. Denosumab may also be helpful for patients who have kidney problems, high calcium levels in the blood, or bone loss that stopped responding to zoledronic acid. One study of 1718 patients showed that denosumab helped delay bone problems by a similar amount of time than zoledronic acid (17.3 months vs. 17.6 months). 15 months after treatment, denosumab significantly slowed bone problems by 34% compared to zoledronic acid. Denosumab also increased the time without tumor growth or spread by 10.7 months compared to zoledronic acid (18% lower risk). Fewer patients treated with denosumab reported kidney problems compared to zoledronic acid (10% vs. 17%).

Surgery may be recommended for patients with painful compression fractures in the spine. These occur when a vertebral bone in the spine gets shorter due to a fracture. Radiation therapy may also be used for these patients to help manage pain. Studies have shown that up to 90% of patients have pain relief after radiation therapy.

This article reviewed different treatment options for managing bone disease that occurs due to multiple myeloma.

Talk to your care team about different treatment options available to you to help manage bone pain and other symptoms.