[Multiple myeloma and bone manifestations. Role of clodronate]

Osteolytic lesions in multiple myeloma are related to osteoclast activation induced by a network of cytokines including IL6, TNF beta or IL1 beta which explain pain, fractures, or hypercalcaemia appearance. Bone destruction is reflected by hydroxyprolinuria and inversely correlated with serum osteocalcin. Lytic lesions or osteopenia are present in 80% of patients on X-ray. MR imaging, is interesting for exploring spinal lesions or the so-called solitary plasmacytomas but still remains a tool in evaluation. After therapies few modifications are demonstrated on roetgenograms while osteodensitometry appears more sensitive. A review of the literature is made showing the prominent place of clodronate in the therapy of hypercalcaemia of multiple myeloma. This drug appears attractive for decreasing osteolysis and perhaps for improving quality of life of patients. Nevertheless, a better definition of its use in clinical practice is necessary.