Bone disease in multiple myeloma

Multiple myeloma is a uniformly fatal hematologic malignancy that results from the clonal expansion of plasma cells within the bone marrow. Skeletal-related complications affect nearly all patients with multiple myeloma and have a major impact on both patient morbidity and mortality. These complications most frequently include the development of osteolytic lesions that lead to severe bone pain, hypercalcemia, and pathologic fractures. Comprehensive skeletal imaging, using first plain radiographs and then more advanced modalities if necessary, is critical both at the time of diagnosis and throughout the course of therapy to assess the skeletal impact of the disease. The widespread use of intravenous bisphosphonate therapy has significantly improved the quality of life of myeloma patients by limiting the amount of osteolytic destruction that occurs. Bisphosphonate treatment, however, does not lead to repair of bone damage that has already occurred. The recent identification of multiple molecular targets with key roles in the osteolytic process has illuminated our understanding of myeloma bone disease, and may transform our future approaches to providing multiple myeloma patients with optimal skeletal care.