Should patients start bone therapy while in remission? 

This week's "Ask Dr. Durie" is an interesting and important question. It comes from a gentleman who asks: "If I'm in remission, do I need to take bone therapy?" 

And so, this gentleman is referring to treatment such as the bisphosphonate Zometa® or the antibody XGEVA®. These are bone treatments that shut down bone destruction triggered by myeloma. 

And so, the question is how important are these types of drugs if you've gone through treatment and have achieved an excellent remission? The important part about that is that when myeloma is in remission, particularly with the newer novel combinations—triplets, which produce excellent deep responses, the myeloma is under excellent control and is not producing any new bone damage. 

At that moment, if you're in a really good deep remission, there is most likely not any urgency to jump in into bone therapy and start taking Zometa or Xgeva. 

My suggestion is to think about this and talk to your doctor about it. If your doctor agrees that you don't have any immediate bone concerns, it may be completely safe enough to follow along on your maintenance myeloma therapy and watch out for any possible new bone issues. 

But unless your myeloma is changing, unless there's some concern about possible relapse, or maybe if you have some new pain, or issues and x-rays and scans are done, it may well be completely safe and just fine to follow along with your myeloma therapy and keep the bone therapy in reserve in case any new bone issues emerge over time. 

And so it's quite interesting to have this opportunity which was certainly not the case in years past when we didn't have these deep and long-lasting remissions which we have with the new novel therapy combinations. So this is excellent news that you don't need to be so dependent on these bone therapies which have been so important for many years for myeloma patients