Common Issues in Supportive Care: Part 1 – Bone Health
Living with multiple myeloma means living with aches, pains, fatigue, and risks for bone fractures and infections. Many of these issues are a direct result of myeloma affecting the bones, blood, and kidneys. Fortunately, there are several options available that can help reduce the impact of common myeloma problems. Be sure you talk regularly to your health care team—together, you can figure out the best management plan for you and, ideally, prevent these issues from developing. In this three part blog series, we will examine bone health, low blood counts and Kidney Disease, Nutrition, & General Health. Part 1 examines bone health.
Why does multiple myeloma pose a risk to your bones? There are actually a couple of reasons. First, multiple myeloma is a cancer of your blood cells (specifically, your lymphocytes, which are one of several types of B cells). Blood cells are formed in the bone marrow (the soft, spongy tissue that’s located inside the long bones of your body), and as myeloma cells grow and crowd out the normal blood cells in the bone marrow, the surrounding bone is also affected. Second, myeloma cells boost the activity of other cells that are responsible for breaking down bone. The action of these cells causes small holes (called lytic lesions) to develop in bones, which weakens them. Physicians are able to view these holes when they take an x-ray. Bone damage caused by myeloma leads to the leaking of calcium into the bloodstream (a condition called hypercalcemia). Ultimately, damaged bones cause pain and put patients at risk of fractures, spinal cord compressions, or vertebral bone collapse. In fact, most patients are first diagnosed with myeloma after they go to their doctor with pain and discomfort caused by myeloma-related bone damage. A majority of myeloma patients (about 85%) have bone disease.
Can damage to the bone be stopped? Yes, it can be stopped in a couple of ways. Getting treatment for the myeloma itself is a first step so that the number of myeloma cells in the bone marrow can be reduced. Next, drugs called bisphosphonates (currently marketed as Zometa and Aredia) can be given to prevent more bone damage or to keep existing damage from getting worse. Bisphosphonates slow bone destruction by putting the brakes on the cells that break down bone. They help to reduce pain and reduce the risk of bone fracture.
Xgeva is another medication used to help stop bone damage caused by myeloma. Though it works in a similar way to bisphosphonates—stopping the cells that break down bone—Xgeva is from a different class of drugs called monoclonal antibodies. For patients who cannot take bisphosphonates (because, for example, they have kidney problems), Xgeva may be a good choice.
Unfortunately, these drugs cannot rebuild damaged bones. Bisphosphonates are administered as an intravenous (IV) infusion and Xgeva is administered under the skin (subcutaneously) and all drugs carry risks of side effects. The most serious of these is a condition that results in bone damage to the jaw. Known as osteonecrosis of the jaw (ONJ), this painful condition causes the bone of the jaw to be exposed through the skin. Luckily, this side effect is very uncommon. Making sure to get major dental work (for example, root canals and tooth extractions) before receiving bisphosphonate therapy is one way to reduce the chance of getting ONJ. Importantly, ONJ can be prevented with good oral hygiene practices—things like regular teeth cleanings. It is also important to communicate with your dentist about being on any of these medications.
There are things you can do to help maintain good bone health. Eating calcium-rich foods (for example, cheese, beans, some kinds of fish) can help. Taking calcium and vitamin D supplements—but only as recommended by your doctor—and performing weight-bearing exercise (with caution) can also help to maintain bone health.
Nurse Patient Navigators in the MMRF Patient Support Center are always available at 888-841-6673 to help answer any questions you have or to help you find the right resources to help in your fight against myeloma.
MMRF. 2019 Patient Summits.
MMRF. MMRF Patient Toolkit. Multiple Myeloma Disease Overview.