The role of bisphosphonates in multiple myeloma

Multiple myeloma (MM) is the second most common hematologic malignancy and the most common malignancy to involve bone. More than 85% of patients with MM have bone involvement, which can be devastating. Bisphosphonate therapy is the mainstay of treatment for MM bone disease; it has decreased the frequency of skeletal events in MM and delayed their development. Further, the toxicity of these drugs is low and generally manageable. Whether bisphosphonates have any antitumor effects in MM patients (in contrast to what has been reported in preclinical models) is unclear and requires further study. Although bisphosphonates have been extremely effective for treating MM bone disease, they do not completely inhibit the development of skeletal events, but only decrease them significantly. Other antiresorptive agents now being developed may further enhance the quality of life for MM patients when used in combination with bisphosphonates.