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Bisphosphonates in multiple myeloma.

B Djulbegovic¹, K Wheatley, J Ross

¹Dpt. of Internal Medicine I, Univ. of Bonn, Sigmund-Freud-Str. 25, Bonn, Germany.

The Cochrane Database of Systematic Reviews

|July 26, 2002

Summary

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Bisphosphonates significantly reduce pathological vertebral fractures and pain in multiple myeloma patients. However, current evidence does not show a benefit for overall mortality, with clodronate and pamidronate being preferred agents.

Area of Science:

Oncology
Pharmacology
Bone Metabolism

Background:

Multiple myeloma involves plasma cell proliferation leading to bone destruction.
Bisphosphonates inhibit osteoclastic activity, suggesting a therapeutic role.
The precise clinical impact of bisphosphonates in multiple myeloma requires clarification.

Purpose of the Study:

To evaluate bisphosphonates' effect on skeletal-related morbidity and mortality in multiple myeloma.
To assess bisphosphonates' impact on pain, quality of life, and hypercalcemia incidence.

Main Methods:

Systematic review and meta-analysis of randomized controlled trials.
Searched MEDLINE, LILACS, EMBASE, and Cochrane Controlled Trials Register.
Data extraction and analysis using Peto odds ratios and absolute risk reduction.

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Main Results:

Bisphosphonates significantly reduced pathological vertebral fractures (OR=0.59) and pain (OR=0.59).
Absolute risk reduction indicates treating 10 patients prevents one vertebral fracture.
No significant effect on mortality, non-vertebral fractures, or hypercalcemia was observed.

Conclusions:

Bisphosphonates effectively decrease pathological vertebral fractures and pain in multiple myeloma.
Current evidence does not support bisphosphonates reducing mortality in this patient group.
Clodronate or pamidronate appear to be the preferred bisphosphonate agents based on available data.