Bone Health and Multiple Myeloma

If you have multiple myeloma, taking care of your bones is an important part of your treatment plan. The disease can raise your chances of breaks and other problems. But you have a number of ways to keep bone damage at bay.

How Multiple Myeloma Hurts Your Bones

In multiple myeloma, cancer starts in white blood cells in your bone marrow, the spongy center of bones where blood cells are made.

The cancer cells divide and grow. As they do, they crowd out cells that nourish your bones and keep them strong. This can lead to calcium loss and give you soft spots called osteolytic lesions.

Bone Health Checks

Before you start any treatments to curb bone loss, you'll want to get a clear idea of how your bones are doing. Your doctor will likely suggest you get X-rays to look for damage like holes or thin spots.

You may also get PET or MRI scans to find small areas of early bone disease before it spreads.

Bone-Strengthening Drugs

Your doctor may prescribe drugs called bisphosphonates, such as pamidronate (Aredia) and zoledronic acid (Zometa). They slow down the activity of osteoclasts -- cells that break down bone. That allows bone-building cells called osteoblasts to move in and strengthen your bones.

Studies show bisphosphonates cut down the number of fractures in people with multiple myeloma.

Your doctor may have you take the drugs through an IV every few weeks. Side effects are rare, but about 1 in 1,000 people get less blood flowing to the jaw, which can lead to bone decay there.

Radiation Therapy

Radiation kills cancer cells that moved into your bones, which opens up new space for healthy bone cells to grow. Once the cancer cells are gone, your bones will naturally grow back thicker and stronger.

Radiation treatments are now more targeted than ever before. Your doctor can direct the treatment to the precise area where cancer cells are attacking your healthy bone tissue.

Spine Surgery

Your doctor may find areas of moderate to severe bone damage in your vertebrae, the row of knuckle-sized bones that make up your spine. If this happens to you, you'll need immediate treatment so you can stay mobile and pain-free. A variety of procedures can correct the problem.

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One way to stabilize your spine is called vertebroplasty. Your doctor injects a cement-like substance directly into a hollowed-out vertebra to shore it up.

In another procedure, called kyphoplasty, your doctor puts a tiny balloon into a vertebra and then expands the balloon. They then put cement into the pocket that's been created.

If these two procedures don't work, or if they're not right for you, your doctor may recommend more extensive surgery. It's also an option if you have severe bone damage that's painful and makes it hard to move.

For this surgery, your doctor will add metal plates, screws, or mesh to reconstruct your vertebrae or secure the bones in place. Sometimes your doctor will remove as many of your tumors as possible during the same procedure.

After surgery, your doctor will likely recommend a rehab program to help you regain your strength and make it easier to move.

Monoclonal Antibodies

Monoclonal antibodies are treatments that use the immune system -- your body's defense against germs -- to fight multiple myeloma.

Drugs like daratumumab (Darzalex) and elotuzumab (Empliciti) encourage your body to block bone-destroying cells that become overactive in multiple myeloma.

Since monoclonal antibodies slow the process of bone breakdown, they treat your cancer at the same time that they cut your odds of getting fractures and excess calcium deposits.

Physical Activity

Exercise has lots of benefits. One study shows that people with cancers like multiple myeloma who get regular physical activity have less depression and more energy.

Sticking to a fitness routine is a good way to keep your ability to move around if you have bone problems that cause pain and stiffness. Weight-bearing exercise, such as walking, also helps build up and strengthen your bones.

Nutrition

It's smart to eat calcium-rich foods like milk, cheese, yogurt, which will help strengthen your bones as you fight multiple myeloma.

But for an extra bone boost, your doctor may suggest a calcium supplement of 1,000-1,200 milligrams a day. Your doctor may check first to make sure you don't have hypercalcemia -- high levels of calcium in your blood.

In addition, vitamin D supplements of 800-1,000 international units a day can help lower your chances of breaking a bone. Check with your doctor first to see if it's a good idea.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on October 28, 2019

Sources

SOURCES:

International Myeloma Foundation: "What Is Multiple Myeloma?"

Memorial Sloan Kettering Cancer Center: "Bone-Related Problems in Multiple Myeloma."

International Myeloma Foundation: "Bone Disease," "Imaging studies."

Mayo Clinic Proceedings: "Bisphosphonates: Mechanism of Action and Role in Clinical Practice."

Cochrane: "Bisphosphonates in Multiple Myeloma."

International Myeloma Foundation: "Bone Health, Pain, and Mobility."

Orthopaedic Surgery: "Consensus on Surgical Management of Myeloma Bone Disease."

Hematology Reports: "Bone-Targeted Agents in Multiple Myeloma."

National Osteoporosis Foundation: "Osteoporosis Exercise for Strong Bones."

Clinical Journal of Oncology Nursing: "Maintaining Bone Health in Patients with Multiple Myeloma."

American Cancer Society: "Drug Therapy for Multiple Myeloma."

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