Practice patterns in myeloma bone disease: a multi-center survey

Bone disease is a common manifestation of multiple myeloma. Although anti-resorptive therapy is recommended by guidelines, implementation can be variable. We sought to evaluate practice patterns for myeloma bone disease management and to identify opportunities for harmonization.

An online survey was distributed to clinicians who see patients with multiple myeloma at medical centers affiliated with the Big Ten Cancer Research Consortium. Anonymous responses were collected regarding self-reported demographics, as well as practice patterns regarding preferred antiresorptive agent, dosing, duration of therapy, therapy modifications, vitamin and mineral supplementation, dental restrictions, and management at relapse.

A total of 100 responses were collected from 11 different academic institutions and their community-affiliated sites. Respondents were predominantly physicians (74%) working in an academic setting (77%), with variable time practicing independently and number of myeloma patients seen per year. Most respondents (89%) reported using zoledronic acid as the preferred agent, with every 4 weeks as the most common frequency (for zoledronic acid 70%, denosumab 64%), with most administering therapy for 2 years (72%). Most clinical scenarios did not affect anti-resorptive choice at diagnosis, except for severe renal insufficiency. Dental recommendations were heterogeneous. There was low utilization of biomarkers to guide management decisions.

Our survey suggests that at the time of diagnosis, most clinicians administer appropriate supportive care for myeloma bone disease. Further study is needed to help unify practice patterns in the relapsed setting, when dental care is suboptimal, and when it is appropriate to tailor such therapy.