Abstract
Recent advances in the treatment of multiple myeloma have resulted in improved prognosis, but bone lesions remain a major concern in these patients. Multiple myeloma bone disease is characterized by increased bone resorption and decreased bone formation. Myeloma bone lesions are osteolytic and are often associated with pain, pathologic fractures, hypercalcemia, spinal cord compression and increased mortality. A multidisciplinary approach is needed to manage multiple myeloma bone lesions. Current management of multiple myeloma bone disease involves the combination of anti-myeloma therapy, anti-resorptive therapy, and if necessary a local treatment of skeletal lesions. Bisphosphonates are the current standard of care for reduction in skeletal-related events. Radiotherapy or surgery can be used for specific conditions such as uncontrolled pain, pathologic fractures or spinal cord compression. Vertebroplasty or kyphoplasty should be considered in case of symptomatic vertebral fractures. Other treatments targeting dickkopf-1, activin-A, and BAFF are under development.
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