An Evidence-Based Approach to Myeloma Bone Disease

Multiple myeloma is an incurable clonal plasma cell malignancy characterised by osteolytic bone lesions and the presence of a monoclonal immunoglobulin. The bone disease caused by myeloma is a major cause of morbidity with the related complications of pathological fractures, hypercalcaemia and bone pain affecting both quality of life and patient survival. The osteolytic lesions arise due to an imbalance of osteoclast and osteoblast function, arising from complex interactions between myeloma cells, bone marrow stromal cells and the bone marrow microenvironment. These advances in understanding of the pathophysiology have directly led to improvements in patient management and outcomes. Recent advances in myeloma bone disease are reviewed, including the role of novel and emerging therapies, and evidence-based management strategies for myeloma bone disease are discussed.