Multiple Myeloma Bone Disease Treatments
Treatment: Bisphosphonates and Other Medications
Bisphosphonates are drugs that help prevent myeloma bone disease from getting worse, decrease bone pain, and reduce the likelihood of fracture. They are prescribed in the majority of patients and are more potent than other bisphosphonates that are used to treat osteoporosis in people who do not have cancer. These medications are also used to treat hypercalcemia (elevated calcium levels in the blood), another common problem in myeloma. Bisphosphonates are given intravenously approximately every four weeks.
Potentially serious side effects with bisphosphonates include reduced kidney function (renal impairment) and osteonecrosis of the jaw (ONJ), a painful condition in which the jawbone is exposed.
To reduce the risk of developing kidney impairment during therapy, creatinine levels (a protein that is an indicator of potential concerns) are monitored by blood tests. Blood tests are done before each dose of bisphosphonate therapy, and the dose will be reduced if there are significant increases in creatinine levels. Some studies indicate that long-term use of bisphosphonates may be associated with a small risk of damage to the jawbone known as osteonecrosis. To reduce the chance of developing osteonecrosis of the jaw, patients receiving
bisphosphonates should practice good oral hygiene and schedule regular dental visits. Tell your dentist if you are receiving bisphosphonates.
Another bone supportive therapy that is not a bisphosphonate, Xgeva (denosumab), is being studied in a Phase III trial in patients with multiple myeloma. Xgeva is a novel agent that is currently approved by the FDA to prevent bone complications in patients with other types of cancers.
Treatment: Orthopedic Interventions
Orthopedic interventions may be required to help control pain or maintain function or mobility. These may include physical therapy, splinting of bones, or surgical intervention to prevent or treat fractures or procedures to repair compression fractures of the spine. Two minimally invasive surgical procedures—vertebroplasty and balloon kyphoplasty—are used to reinforce the vertebra of the spine and usually can be done without hospitalization.These procedures help relieve pain and improve function and quality of life in patients with myeloma.
Treatment: Radiation Therapy
Low–dose radiation therapy may sometimes be used to reduce bone pain in myeloma patients. It is directed to specific bone lesions that are causing problems. However, it can affect the bone marrow and result in reduced blood counts, which may cause anemia, a weakened immune system, and blood clotting problems.