Multiple myeloma can cause you to have bone pains and weak or easily broken bones. Caring for your bones is an important part of your treatment plan that can significantly improve your health, well-being, and quality of life.
How Does Multiple Myeloma Affect Your Bones?
Multiple myeloma is a blood cancer that occurs when white blood cells, called plasma cells, increase out of control in the bones.
Myeloma destroys the bone by making osteoclasts – cells that break down old bones – become more active and weaken your bones. At the same time, myeloma cells slow down the activity of osteoblasts – cells that lay down new bone. These soft spots are called lytic lesions. Increased bone breakdown and decreased bone building result in bones that break or collapse with little or no trauma. These are called pathologic fractures.
Up to 80% of people with myeloma have holes in their bones – called lytic bone lesions – at the time of the diagnosis, and 60% will have broken bones during their illness.
How to Maintain Bone Health if You Have Multiple Myeloma
Before your doctor puts you on a treatment plan for your bones, they might look at how myeloma cells are affecting your bones. They could use imaging devices to scan for signs of bone diseases.
Your doctor may create a treatment plan that may involve other specialist care. Your care team may have:
- A medical oncologist: A doctor who uses medicines to treat cancer
- An orthopedic surgeon: A surgeon for bone diseases
- A radiation oncologist: A doctor who uses radiation therapy to treat cancer
- An oncologist
Your doctor may recommend the following ways to treat bone diseases and improve your bone health.
- Diet and Lifestyle Changes
Your doctor might put you on an exercise and nutrition plan to help maintain bone health and relieve bone pain.
Although you may think that you shouldn’t move around or do physical activities if you have weak or easily broken bones, evidence suggests otherwise. Being physically active can help you to be more fit and manage myeloma symptoms like fatigue, anxiety, depression, and bone loss.
Your doctor will create an exercise plan that isn’t too demanding and accommodates your unique case. Speak with your doctor before starting any exercise plans.
Your doctor may also recommend a more balanced diet with plenty of calcium and vitamin D-rich foods to support strong, healthy bones.
Your doctor may prescribe calcium and vitamin D supplements, especially if your bones are already weak or you are on certain bone-modifying medications, like pamidronate.
But before your doctor prescribes calcium, they’ll confirm that your blood calcium levels aren’t high and that you don’t have kidney problems. Don’t take calcium supplements or other supplements for bone problems without first talking with your doctor.
Your doctor may also tell you to:
- Follow healthy sleep habits.
- Avoid alcohol or smoking.
- Limit how much processed food you eat.
- Avoid drinking green tea if they put you on bortezomib, an anti-cancer medication for myeloma.
- Bone-Modifying Medications
Your doctor might put you on bone-modifying medications whether or not you have bone disease. You can take these prescription medications by mouth or through your vein with a drip.
These medications could:
- Prevent bone diseases
- Manage bone pains
- Slow down bone loss
- Treat bone diseases
- Make your bones stronger
- Improve your bone health
The most common bone-modifying medications your doctor might recommend are bisphosphonates, which slow bone loss, like zoledronate and pamidronate, or denosumab (Prolia, Xgeva). You could be on these bone medications for up to 2 years.
Osteonecrosis of the jaw, or jaw death, is possible if you get high doses of bisphosphonates or denosumab through your veins. As the name hints, this severe and painful condition occurs when the jaw bone cells die. But this side effect is rare.
It’s advisable that a doctor checks for and treats any mouth infections before giving you bone-modifying medications through your vein.
Try to maintain proper oral habits and avoid serious dental procedures like tooth extraction while taking these medications. If you need to have serious dental work, talk to your doctor first, as they might stop your medicines for some time.
- Pain-Relieving Medications
If you’re having bone pains, a doctor may prescribe analgesics, or pain-relieving medications, to ease your pain and make you feel better.
Your doctor will ask you questions about your pain. Some questions to expect are:
- When did this pain start?
- How long have you been feeling this pain?
- Where are you feeling this pain?
- Is your pain dull, sharp, burning, or stabbing?
- When do you feel pain?
Your doctor may recommend other analgesics aside from nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen. NSAIDs can make you prone to kidney injury. Taking pain medications for bone diseases will also save you the emotional distress of enduring pain.
- Radiation Therapy
Your treatment plan may also include radiation therapy. This therapy is used to shrink cancer cells in the bone and manage bone pain.
Radiation therapy is painless, and lower doses are unlikely to cause side effects. Chest or spine radiation may cause nausea, vomiting, and a poor appetite.
You may also feel tired after radiation therapy. Your doctor can help you manage pain during and after this therapy.
- Surgery
Your doctor might recommend surgery if you have fractures in your vertebrae, or backbone. This surgery will relieve any pain you might have due to the fractures. It is also used to prevent collapse of affected vertebrae, which could result in cord compression and paralysis.
You may have a kyphoplasty or vertebroplasty procedure. Both surgeries involve injecting a special cement into the fractured vertebrae.
This procedure is generally safe, but you might be at risk of having an infection, bleeding, back pain, or numbness afterward.
