Multiple myeloma and bone health: What patients need to know
Although multiple myeloma is classified as a blood cancer, patients with this disease often experience bone-related symptoms, too. This includes bone pain, frequent fractures and spots of low bone density or bone damage that show up during a skeletal scan.
Here, Amrita Krishnan, M.D., director of City of Hope's Multiple Myeloma Program, answers questions about this cancer's connection to bone health and what patients and their care team can do about it.
How does multiple myeloma affect bone health?
In a normal body, bones are constantly being maintained by two types of cells: osteoblasts that create new bone matter and osteoclasts that break it down and reabsorb it. Myeloma cells can disrupt this balance in two ways, by interfering with osteoblasts' bone-building ability while overstimulating osteoclasts' breakdown processes. The result is overall bone loss.
How does this impact the patient?
It depends on how advanced the disease is. Patients diagnosed in earlier stages may notice bone pain, most commonly in the pelvis and lower back. For patients with more advanced disease, their bones can fracture easily and frequently — sometimes even with simple activities such as light lifting and walking.
Are these effects permanent?
Because the myeloma cells are causing the bone loss, the bones should be able to self-repair once the cancer is treated. However, depending on severity and duration of the fractures, some of these breakages may not heal properly and would require medical intervention.
What can myeloma patients and survivors do to build or maintain healthy bones?
The most important thing they can do is to check in with their health care team regularly so that their bones can be carefully monitored and interventions, if needed, can be done in a timely and appropriate manner.
This is especially crucial for multiple myeloma patients because their bone conditions put them in a catch-22. For example, while weight-bearing exercises are normally effective for strengthening bones, for myeloma patients these exercises also can actually increase fracture risk due to their already-weakened bones.
Likewise, patients should avoid taking calcium and vitamin D supplements on their own because myeloma-linked bone loss may also elevate blood calcium levels, a potentially problematic condition that can be exacerbated with further supplementation. Thus, performing physical activities and taking supplements should only be done after a health evaluation and discussion with a physician.
In addition to a carefully planned exercise and supplement regimen, doctors may also prescribe a class of drugs called bisphosphonates, which are also used to treat osteoporosis and other bone loss conditions, to help rebuild bones in multiple myeloma patients and survivors.
What research is being done on myeloma and bone health?
Studies have shown that long-term bisphosphonate use may increase risk for other conditions, such as bone loss in the jaw and thigh bone fractures. Thus, we are looking into finding the ideal dose and duration of biphosphonates to prescribe to maximize its benefit and minimize the side effect risk and severity. We are also conducting clinical trials investigating other bone building agents that may be more effective or do not have the side effects associated with bisphonsphonates.
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