Multiple myeloma (MM) is a cancer of clonal plasma cells primarily affecting older adults, with approximately 35,000 new cases annually in the United States. Advances in treatment, including immunomodulatory drugs, proteasome inhibitors, and stem cell transplants, have improved survival rates, although the disease remains largely incurable. Bone disease is a significant complication in MM, affecting over 80% of patients and contributing to skeletal-related events (SREs) such as fractures and spinal cord compression.

Bone involvement in MM results from the disruption of normal bone remodeling, with malignant plasma cells driving osteoclast activity and inhibiting osteoblast function. This imbalance leads to bone resorption, hypercalcemia, and a high risk of SREs, severely impacting patient quality of life. Bisphosphonates, such as pamidronate and zoledronic acid, have been standard treatments for MM-related bone disease, helping prevent SREs and manage bone pain. Newer therapies, like the monoclonal antibody denosumab, offer additional benefits, especially in patients with renal impairment, and are being integrated into MM treatment guidelines. However, the cost and accessibility of these therapies remain important considerations in treatment decisions.

Reference: Bernstein ZS, Kim EB, Raje N. Bone Disease in Multiple Myeloma: Biologic and Clinical Implications. Cells. 2022;11(15):2308. doi: 10.3390/cells11152308.