Journal Article

Multiple Myeloma Associated Bone Disease

Rasch, Stine, Abildgaard, Niels, Faebo Larsen, Rikke, Østerheden Andersen, Mikkel, Asmussen, Jon Thor, Lund, Thomas, Lerberg Nielsen, Anne

2020

Overview

The lytic bone disease is a hallmark of multiple myeloma, being present in about 80% of patients with newly diagnosed MM, and in more during the disease course. The myeloma associated bone disease (MBD) severely affects the morbidity and quality of life of the patients. MBD defines treatment demanding MM. In recent years, knowledge of the underlying pathophysiology has increased, and novel imaging technologies, medical and non-pharmaceutical treatments have improved. In this review, we highlight the major achievements in understanding, diagnosing and treating MBD. For diagnosing MBD, low-dose whole-body CT is now recommended over conventional skeletal survey, but also more advanced functional imaging modalities, such as diffusion-weighted MRI and PET/CT are increasingly important in the assessment and monitoring of MBD. Bisphosphonates have, for many years, played a key role in management of MBD, but denosumab is now an alternative to bisphosphonates, especially in patients with renal impairment. Radiotherapy is used for uncontrolled pain, for impeding fractures and in treatment of impeding or symptomatic spinal cord compression. Cement augmentation has been shown to reduce pain from vertebral compression fractures. Cautious exercise programs are safe and feasible and may have the potential to improve the status of patients with MM.

• Publisher: MDPI AG,MDPI
• Subject: Bisphosphonates / Bone diseases / Bone marrow / Complications and side effects / Compression / Computed tomography / Drug dosages / Fractures / Immunotherapy / Magnetic resonance imaging / Medical treatment / Monoclonal antibodies / Morbidity / Multiple myeloma / Pain / Pathophysiology / Patients / Physiological aspects / Quality of life / Radiation therapy / Review / Spinal cord / Targeted cancer therapy / Vertebrae