Multiple Myeloma and Osteoporosis: What’s the Link?

Medically Reviewed by Sabrina Felson, MD on June 26, 2022
4 min read

It’s common to lose bone density as you get older. Your body doesn’t replace the cells that rebuild your bones as fast as it used to. When this happens, your bones can become thinner and full of little holes. Doctors call this condition osteoporosis.

Some conditions put you at risk for osteoporosis earlier in life. If you have certain cancers, like multiple myeloma, your bones can become more fragile at any age. More than 80% of people with multiple myeloma have bone issues due to their cancer.

Multiple myeloma is cancer of the plasma cells, a type of white blood cell found in your bone marrow. It upsets the balance between the buildup of new bone and the breakdown of old bone in your body. The cancer cells boost the breakdown process while slowing down bone production.

This can lead to soft spots in your bones that doctors call “osteolytic lesions.” They most often affect your spine, ribs, pelvis, skull, arms, and legs.

It may also mean that too much calcium gets released from your bones into your bloodstream. That can cause a condition called hypercalcemia, which leads to further bone damage.

In this way, multiple myeloma can result in three main types of bone problems:

Bone pain is a common symptom of bone disease caused by multiple myeloma. You might notice it in your hips, back, or ribcage.

If your doctor thinks you may have bone damage from multiple myeloma, they’ll use imaging tests like X-rays and CT scans to diagnose you and to keep track of your bone health.

Treating your multiple myeloma also treats the osteoporosis that results from it. You might have chemotherapy and/or a stem cell transplant to treat the cancer.

Radiation can help by shrinking the tumors that cause bone damage. The cancer cells are then replaced by healthy bone.

Your doctor can also prescribe bisphosphonate drugs like pamidronate (Aredia) and zoledronic acid (Zometa) to slow bone loss. They can ease bone pain as well as preserve your bones. You get them via an IV every month. They may take a while to reach full effectiveness. Your doctor will need to keep an eye on your kidney function if you take these drugs.

Denosumab (Xgeva), another type of drug called a monoclonal antibody, can also help preserve your bones. You get it through a monthly shot under your skin.

Your doctor might suggest you use a neck or back brace to ease pain and provide support. If you have fractures, your doctor could insert metal rods or plates to help support your bones. You could also get a procedure in which your doctor injects bone “cement” into a collapsed vertebra.

Sometimes, multiple myeloma symptoms mimic the signs of age-related osteoporosis. Experts often mistake back or skeletal pain caused by this cancer as a symptom of osteoporosis. That’s one reason doctors may not diagnose multiple myeloma in its early stages.

Other symptoms of multiple myeloma include:

Your doctor might suspect multiple myeloma if there’s something unusual about your osteoporosis symptoms, like:

  • You’re under 50.
  • Your osteoporosis is very serious.
  • You have osteoporosis along with several compression fractures.
  • You’re a male without other risk factors.
  • Tests of your blood find abnormal proteins called monoclonal proteins.

You need to take extra steps to protect your bones if you have multiple myeloma. There are a few things you can do:

Exercise. Regular activity helps to keep your bones strong and maintain your balance, which protects you against falls. Talk to your doctor about what kind of activity and how much is right for your condition.

Eat foods rich in calcium. Calcium-rich foods help strengthen bones. Choose items like cheese, yogurt, and broccoli. Include foods high in vitamin D, like fatty fish and fortified orange juice and milk, to help your body absorb even more calcium.

Seek help with nutrition. A nutritionist or dietitian experienced with multiple myeloma cases can help you plan meals that support your bone health and meet your other nutritional goals. Your doctor can connect you with an expert in your area.

Get to a healthy weight. When you’re underweight, you’re at a higher risk of bone loss. Your doctor or dietitian can give you tips on how to gain and maintain weight in a healthy way.

Protect yourself from falls. Falls are a main cause of bone fractures in people with osteoporosis. Keep your floor clear of clutter and anything else you could trip on. Secure power cords and loose rugs around your home.