Myeloma and bone health: Bone-strengthening and fracture prevention
Fact-checked by Bone problems are among the most challenging complications of multiple myeloma. More than 80% of people diagnosed with myeloma have osteolytic lesions, or areas of severely weakened bone, at the time of diagnosis. The disease can also cause severe bone pain and weaken bones, making you more prone to fractures and other bone complications that negatively affect your well-being.
Protecting myeloma bone health is about more than managing pain. Proactive bone care helps you maintain your independence, lowers your risk of serious future complications, and supports your overall quality of life.
Why does myeloma weaken your bones
Your bones constantly change and adapt through a process called bone remodeling. In this cycle, specialized cells called osteoclasts break down old bone tissue, while osteoblasts build new bone tissue in its place.
Multiple myeloma is a blood cancer that develops when plasma cells become cancerous and grow out of control. Plasma cells are specialized immune cells that normally produce antibodies, and they multiply inside the bone marrow, the spongy tissue inside bones where blood cells are made.
In healthy tissue, plasma cells help support the balance between bone breakdown and bone formation. Myeloma disrupts this cycle because cancerous plasma cells increase osteoclast activity while reducing osteoblast function. As a result, your bones break down faster than your body can rebuild them.
Over time, this imbalance can lead to bone pain, fractures, osteolytic lesions, and spinal cord compression, which occurs when vertebrae break and put pressure on your spinal cord
How bisphosphonates and RANK-L inhibitors help
Two of the main medications used in myeloma bone disease treatment are bisphosphonates and RANKL inhibitors. Both therapies help slow bone loss and reduce your risk of fractures, but they work in different ways:
- Bisphosphonates, such as zoledronic acid, bind to your bone tissue and act as a poison for osteoclasts, causing them to die and helping to slow down bone breakdown.
- RANKL inhibitors, such as denosumab, block a specific signaling pathway that’s important for osteoclast function and bone destruction.
Both treatment types are common in myeloma care and have shown similar safety and efficacy profiles in clinical studies. However, doctors may prefer denosumab if you have kidney concerns because it is less likely to affect kidney function than zoledronic acid.
Both medications also carry a small risk of osteonecrosis of the jaw, a condition where cells in your jawbone die and the dead bone tissue becomes exposed. Before you start treatment, your doctor may recommend a dental exam to identify any problems that could increase this risk. Keeping up with regular dental care during your treatment is also important.
When bone-strengthening treatment is recommended
Targeted bone-strengthening and fracture-prevention therapies are often started soon after diagnosis, even if you aren’t experiencing symptoms of bone disease.
Your oncologist will consider several factors when building your treatment plan, including:
- your kidney function
- whether you have bone lesions
- how well you tolerate treatment
Your treatment plan may also change over time depending on how your myeloma responds to therapy.
Other ways doctors work to prevent fractures
Medication plays a vital role in protecting your bone health in myeloma, but it is not the only strategy.
- Anti-myeloma therapies: Treating the underlying cancer might help slow or stop additional bone damage by reducing cancerous plasma cells in your bone marrow.
- Radiation therapy: Radiation may help treat painful bone lesions and lower your risk of fractures and spinal cord compression.
- Surgery: Minimally invasive procedures such as a vertebroplasty can stabilize weakened vertebrae and provide long-term pain relief, whereas open surgery may be necessary to decompress the spinal cord or address lesions affecting load-bearing joints.
- Physical therapy and low-impact movement: Moving your body can strengthen your muscles and support bone health. A physical therapist with oncology experience can help you stay active safely while reducing strain on weakened bones.
- Calcium and vitamin D supplements: Your doctor might recommend these supplements to help support your overall bone health and ongoing myeloma bone disease treatment.
Your healthcare team can help you determine which strategies are safest and most appropriate for your situation.
Symptoms that may signal worsening bone damage
Paying attention to new or changing symptoms might help you address complications earlier. Symptoms that should be discussed with your medical team include:
- new or worsening bone pain
- sudden or severe back pain, which can signal compression fractures in your spine
- fractures after a minor event, such as lifting something light
- a new curve in your spine, which can occur due to fractures in the vertebra
- new numbness, weakness, or bladder or bowel changes that could signal spinal cord compression
- extreme thirst and frequent urination, which may signal hypercalcemia due to calcium leaking into the bloodstream from deteriorating bones
Some symptoms, such as severe back pain or sudden weakness, require urgent medical attention. If you notice new or rapidly worsening symptoms, contact your healthcare team promptly.
Questions to ask about long-term bone protection
Learning more about your treatment options can help you feel more prepared to manage myeloma bone disease. Questions you may want to discuss with your care team include:
- Do I have bone lesions or signs of bone loss?
- Should I take bone-strengthening medication?
- Which treatment option is safest for my kidney function?
- Should I see a dentist before starting treatment?
- What types of physical activity are safe for me?
- Would I benefit from physical therapy?
- How often will my bone health be monitored?
- What imaging tests will I need?
Protecting your bone health is an ongoing part of multiple myeloma care. Staying informed, communicating openly with your care team, and reporting new symptoms early can help lower your risk of complications and help you stay active and independent.
Rare Cancer News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
