What are the treatment recommendations for bone disease in myeloma patients? 

Multiple Myeloma Patients Experiencing Bone Disease

Multiple myeloma expert Dr. Brian G.M. Durie discusses the treatment options available to myeloma patients experiencing bone disease and if there is a new standard of care for treatment of the disease. 

The BOTTOM LINE: The standard of care for the treatment of bone disease in myeloma patients remains the same. Supportive management of the disease is very important.  

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This week's "Ask Dr. Durie" comes from a patient who's had several bone problems related to his myeloma and he's asking: Are there any new guidelines for the treatment of bone problems for myeloma? 

Well as it turns out the International Myeloma Working Group has just published a new guideline for the care of bone disease in myeloma patients. This is available on the IMF website, but I can give a capsule summary right now of the main new guideline details. 

There are not a lot of new changes in the updated guidelines. The main point is that the standard of care continues to be the bisphosphonate and Zometa® (zoledronic acid) is the bisphosphonate which is recommended monthly for the first 12 months. 

At this point, if things are going well, it's recommended that you talk to your doctor about decreasing the frequency of the dosing to perhaps every three months or maybe even to consider stopping the Zometa at that point. 

There is another active treatment for bone disease in myeloma. This is called denosumab, which is a monoclonal antibody, and this is a helpful option in patients who do have kidney issues. However, the thing to be aware of with this treatment is that if you stop it after a year or two then there is a rebound effect, and this has to be covered by actually taking a bisphosphonate for a few months to prevent any problems with the rebound. 

Apart from those details, other recommendations pretty much stay the same. We still recommend cement augmentation for the painful collapse of a vertebra, where cement is injected into the vertebra. 

We also continue to recommend the use of radiation, and occasionally surgery, if there are a lot of bone damage issues, particularly with pain. 

And so, the BOTTOM LINE is that the standard of care remains pretty much the same. But it is incredibly important to continue with the support of care for bones because these are issues that can affect your day-to-day life. 

Image of Dr. Brian G.M. DurieProfessor of Medicine, Hematologist/Oncologist, and Honoree MD at the University of Brussels, Dr. Brian G.M. Durie is the Chairman of the Board and Chief Scientific Officer of the IMF. Dr. Durie is also the Chairman of the International Myeloma Working Group (IMWG)—a consortium of more than 250 myeloma experts from around the world—and leads the IMF’s Black Swan Research Initiative® (BSRI). 


Source URL: https://www.myeloma.org/videos/are-treatment-recommendations-bone-disease-myeloma-patients