Prevention and Treatment of Myeloma Bone Disease

Curr Hematol Malig Rep. 2012 Dec;7(4):249-57. doi: 10.1007/s11899-012-0135-0.


Osteolytic bone disease is the most common complication of multiple myeloma, resulting in skeletal-related events (SREs) that cause significant morbidity. Bone destruction in myeloma is due to an increased activity of osteoclasts coupled with suppressed bone formation by osteoblasts. Currently, bisphosphonates are the mainstay of the treatment of myeloma bone disease. Zoledronic acid and pamidronate have shown similar efficacy in reducing SREs in a randomized study in the conventional chemotherapy era. However, in a recent study (the Myeloma-IX trial of the UK Medical Research Council, MRC), zoledronic acid was found to be superior to clodronate in reducing SREs, but also it produced a survival advantage of approximately 10 months in patients with bone disease at baseline. During recent years, novel agents targeting bone have been used in myeloma. This review focuses on the established therapy of myeloma bone disease and also on recent advances in treatment that take advantage of the better understanding of the pathophysiology of bone disease.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Activins / antagonists & inhibitors
  • Bone Density Conservation Agents / adverse effects
  • Bone Density Conservation Agents / therapeutic use*
  • Bone Morphogenetic Proteins / antagonists & inhibitors*
  • Bone Neoplasms / etiology
  • Bone Neoplasms / physiopathology
  • Bone Neoplasms / therapy*
  • Diphosphonates / adverse effects
  • Diphosphonates / therapeutic use
  • Humans
  • Immunomodulation
  • Multiple Myeloma / complications*
  • Multiple Myeloma / physiopathology
  • Proteasome Inhibitors / therapeutic use*
  • Tumor Necrosis Factor Inhibitors
  • Wnt Signaling Pathway / physiology


  • Bone Density Conservation Agents
  • Bone Morphogenetic Proteins
  • Diphosphonates
  • Proteasome Inhibitors
  • Tumor Necrosis Factor Inhibitors
  • Activins