[Management of bone disease in multiple myeloma]

Bone disease associated with multiple myeloma(MM)is characterized by increased osteoclast activity and suppressed osteoclast function because of some factors produced by myeloma cells, leading to severe osteolytic lesions. Conventional radiography has been recognized as the gold standard for evaluating the severity of bone lesions caused by MM. However, other imaging techniques such as computed tomography(CT), magnetic resonance imaging, and positron emission tomography with CT are widely used, because conventional radiography has some limitations. Good control of MM itself is very important in order to manage bone lesions caused by MM. Bisphosphonate(BP), a potent inhibitor of osteoclast activity and function, should be used as adjunctive therapy for MM bone disease. Recently, the MRC Myeloma IX trial demonstrated improved survival and delayed disease progression with the use of an intravenous BP, zoledronate, in patients with newly diagnosed MM. Its results may lead to an alteration of guidelines for BP treatments of MM. In the future, novel agents that enhance osteoblastic function, such as bortezomib, may alter the way MM bone lesions are managed.